Cargando…
Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study
INTRODUCTION: HIV self‐testing (HIVST) increases HIV testing uptake among men; however, the linkage to antiretroviral therapy (ART) among HIVST users is low. Innovative strategies for ART initiation are needed, yet little is known about the unique barriers to care experienced by male HIVST users, an...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196890/ https://www.ncbi.nlm.nih.gov/pubmed/35700027 http://dx.doi.org/10.1002/jia2.25950 |
_version_ | 1784727282529599488 |
---|---|
author | Hubbard, Julie A. Mphande, Misheck Phiri, Khumbo Balakasi, Kelvin Hoffman, Risa M. Daniels, Joseph Choko, Augustine Coates, Thomas J. Dovel, Kathryn |
author_facet | Hubbard, Julie A. Mphande, Misheck Phiri, Khumbo Balakasi, Kelvin Hoffman, Risa M. Daniels, Joseph Choko, Augustine Coates, Thomas J. Dovel, Kathryn |
author_sort | Hubbard, Julie A. |
collection | PubMed |
description | INTRODUCTION: HIV self‐testing (HIVST) increases HIV testing uptake among men; however, the linkage to antiretroviral therapy (ART) among HIVST users is low. Innovative strategies for ART initiation are needed, yet little is known about the unique barriers to care experienced by male HIVST users, and what ART‐related interventions men desire. METHODS: We conducted semi‐structured in‐depth interviews with cisgender men (≥15 years) in Malawi who tested HIV positive using HIVST between 2018 and 2020, as well as interviews with their female partners (≥15 years) who distributed the HIVST kits. Medical records from seven facilities were used to identify respondents. We included men who received HIVST from a health facility (primary distribution) and from sexual partners (secondary distribution). Interview guides focused on unique barriers to ART initiation following HIVST and desired interventions to improve linkage and initiation. Interviews were audio recorded, translated and transcribed to English, and analysed using constant comparison methods in Atlas.ti v.8.4. Themes were compared by HIVST distribution strategy. Data were collected between 2019 and 2020. RESULTS: Twenty‐seven respondents were interviewed: eight male/female dyads (16 respondents), eight men without a female partner and three women who represented men who did not participate in the study. Among the 19 men represented (16 men interviewed in person, three represented by secondary report from female partners), seven received HIVST through primary distribution, 12 through secondary distribution. Six men never initiated ART (all secondary HIVST distribution). Barriers to ART initiation centred on the absence of healthcare workers at the time of diagnosis and included lack of external motivation for linkage to care (men had to motivate themselves) and lack of counselling before and after testing (leaving ART‐related fears and misconceptions unaddressed)––the latter was especially true for secondary HIVST distribution. Desired interventions were similar across distribution strategies and included ongoing peer mentorship for normalizing treatment adherence, counselling messages tailored to men, outside‐facility services for convenience and privacy, and facility navigation to help men understand how to navigate ART clinics. CONCLUSIONS: Male HIVST users face unique challenges to ART initiation, especially those receiving HIVST through secondary distribution. Male‐tailored interventions are desired by men and may help overcome barriers to care. |
format | Online Article Text |
id | pubmed-9196890 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-91968902022-06-21 Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study Hubbard, Julie A. Mphande, Misheck Phiri, Khumbo Balakasi, Kelvin Hoffman, Risa M. Daniels, Joseph Choko, Augustine Coates, Thomas J. Dovel, Kathryn J Int AIDS Soc Research Articles INTRODUCTION: HIV self‐testing (HIVST) increases HIV testing uptake among men; however, the linkage to antiretroviral therapy (ART) among HIVST users is low. Innovative strategies for ART initiation are needed, yet little is known about the unique barriers to care experienced by male HIVST users, and what ART‐related interventions men desire. METHODS: We conducted semi‐structured in‐depth interviews with cisgender men (≥15 years) in Malawi who tested HIV positive using HIVST between 2018 and 2020, as well as interviews with their female partners (≥15 years) who distributed the HIVST kits. Medical records from seven facilities were used to identify respondents. We included men who received HIVST from a health facility (primary distribution) and from sexual partners (secondary distribution). Interview guides focused on unique barriers to ART initiation following HIVST and desired interventions to improve linkage and initiation. Interviews were audio recorded, translated and transcribed to English, and analysed using constant comparison methods in Atlas.ti v.8.4. Themes were compared by HIVST distribution strategy. Data were collected between 2019 and 2020. RESULTS: Twenty‐seven respondents were interviewed: eight male/female dyads (16 respondents), eight men without a female partner and three women who represented men who did not participate in the study. Among the 19 men represented (16 men interviewed in person, three represented by secondary report from female partners), seven received HIVST through primary distribution, 12 through secondary distribution. Six men never initiated ART (all secondary HIVST distribution). Barriers to ART initiation centred on the absence of healthcare workers at the time of diagnosis and included lack of external motivation for linkage to care (men had to motivate themselves) and lack of counselling before and after testing (leaving ART‐related fears and misconceptions unaddressed)––the latter was especially true for secondary HIVST distribution. Desired interventions were similar across distribution strategies and included ongoing peer mentorship for normalizing treatment adherence, counselling messages tailored to men, outside‐facility services for convenience and privacy, and facility navigation to help men understand how to navigate ART clinics. CONCLUSIONS: Male HIVST users face unique challenges to ART initiation, especially those receiving HIVST through secondary distribution. Male‐tailored interventions are desired by men and may help overcome barriers to care. John Wiley and Sons Inc. 2022-06-14 /pmc/articles/PMC9196890/ /pubmed/35700027 http://dx.doi.org/10.1002/jia2.25950 Text en © 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Articles Hubbard, Julie A. Mphande, Misheck Phiri, Khumbo Balakasi, Kelvin Hoffman, Risa M. Daniels, Joseph Choko, Augustine Coates, Thomas J. Dovel, Kathryn Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study |
title | Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study |
title_full | Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study |
title_fullStr | Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study |
title_full_unstemmed | Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study |
title_short | Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study |
title_sort | improving art initiation among men who use hiv self‐testing in malawi: a qualitative study |
topic | Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196890/ https://www.ncbi.nlm.nih.gov/pubmed/35700027 http://dx.doi.org/10.1002/jia2.25950 |
work_keys_str_mv | AT hubbardjuliea improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT mphandemisheck improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT phirikhumbo improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT balakasikelvin improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT hoffmanrisam improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT danielsjoseph improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT chokoaugustine improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT coatesthomasj improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy AT dovelkathryn improvingartinitiationamongmenwhousehivselftestinginmalawiaqualitativestudy |