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Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives

A major limiting factor in combatting the HIV epidemic has been the identification of people living with HIV. Index testing programs were developed to face that challenge. Index testing is a focused HIV testing service approach in which family members and partners of people living with HIV are offer...

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Autores principales: Mugisha, Nancy, Tirera, Fatoumata, Coulibaly-Kouyate, Naraba, Aguie, William, He, Yao, Kemper, Kathryn, Robinson, Julia, N’Goran, Luc, Tuho, Moïse, Kouyate, Seydou, Doumbia, Yacouba, Gloyd, Stephen, Kone, Ahoua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9907845/
https://www.ncbi.nlm.nih.gov/pubmed/36753518
http://dx.doi.org/10.1371/journal.pone.0280623
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author Mugisha, Nancy
Tirera, Fatoumata
Coulibaly-Kouyate, Naraba
Aguie, William
He, Yao
Kemper, Kathryn
Robinson, Julia
N’Goran, Luc
Tuho, Moïse
Kouyate, Seydou
Doumbia, Yacouba
Gloyd, Stephen
Kone, Ahoua
author_facet Mugisha, Nancy
Tirera, Fatoumata
Coulibaly-Kouyate, Naraba
Aguie, William
He, Yao
Kemper, Kathryn
Robinson, Julia
N’Goran, Luc
Tuho, Moïse
Kouyate, Seydou
Doumbia, Yacouba
Gloyd, Stephen
Kone, Ahoua
author_sort Mugisha, Nancy
collection PubMed
description A major limiting factor in combatting the HIV epidemic has been the identification of people living with HIV. Index testing programs were developed to face that challenge. Index testing is a focused HIV testing service approach in which family members and partners of people living with HIV are offered testing. Despite the implementation of index testing, there is still a gap between the estimated number of people living with HIV and those who know their status in Côte d’Ivoire. This study aimed to understand the implementation process of index testing in Côte d’Ivoire and to identify implementation challenges from healthcare workers perspectives. In January and February 2020, we conducted a qualitative study through 105 individual semi-structured interviews regarding index testing with clinical providers (physicians, nurses, and midwives) and non-clinical providers (community counselors and their supervisors) at 16 rural health facilities across four regions of Côte d’Ivoire. We asked questions regarding the index testing process, index client intake, contact tracing and testing, the challenges of implementation, and solicited recommendations on improving index testing in Côte d’Ivoire. The interviews revealed that index testing is implemented by non-clinical providers. Passive referral, by which the index client brought their contact to be tested, and providers referral, by which a healthcare worker reached out to the index client’s contact, were the preferred contact tracing and testing strategies. There was not statistically significant difference between immediate and delayed notification. Reported challenges of index testing implementation included index cases refusing to give their partner’s information or a partner refusing to be tested, fear of divorce, societal stigma, long distances, lack of appropriate training in index testing strategies, and lack of a private room for counseling. The recommendations given by providers to combat these was to reinforce HIV education among the population, to train healthcare workers on index testing strategies, and to improve infrastructure, transportation, and communication resources. The study showed that the elements that influenced the process of index testing in Côte d’Ivoire were multifactorial, including individual, interpersonal, health systems, and societal factors. Thus, a multi-faceted approach to overcoming challenges of index testing in Côte d’Ivoire is needed to improve the yield of index testing.
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spelling pubmed-99078452023-02-08 Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives Mugisha, Nancy Tirera, Fatoumata Coulibaly-Kouyate, Naraba Aguie, William He, Yao Kemper, Kathryn Robinson, Julia N’Goran, Luc Tuho, Moïse Kouyate, Seydou Doumbia, Yacouba Gloyd, Stephen Kone, Ahoua PLoS One Research Article A major limiting factor in combatting the HIV epidemic has been the identification of people living with HIV. Index testing programs were developed to face that challenge. Index testing is a focused HIV testing service approach in which family members and partners of people living with HIV are offered testing. Despite the implementation of index testing, there is still a gap between the estimated number of people living with HIV and those who know their status in Côte d’Ivoire. This study aimed to understand the implementation process of index testing in Côte d’Ivoire and to identify implementation challenges from healthcare workers perspectives. In January and February 2020, we conducted a qualitative study through 105 individual semi-structured interviews regarding index testing with clinical providers (physicians, nurses, and midwives) and non-clinical providers (community counselors and their supervisors) at 16 rural health facilities across four regions of Côte d’Ivoire. We asked questions regarding the index testing process, index client intake, contact tracing and testing, the challenges of implementation, and solicited recommendations on improving index testing in Côte d’Ivoire. The interviews revealed that index testing is implemented by non-clinical providers. Passive referral, by which the index client brought their contact to be tested, and providers referral, by which a healthcare worker reached out to the index client’s contact, were the preferred contact tracing and testing strategies. There was not statistically significant difference between immediate and delayed notification. Reported challenges of index testing implementation included index cases refusing to give their partner’s information or a partner refusing to be tested, fear of divorce, societal stigma, long distances, lack of appropriate training in index testing strategies, and lack of a private room for counseling. The recommendations given by providers to combat these was to reinforce HIV education among the population, to train healthcare workers on index testing strategies, and to improve infrastructure, transportation, and communication resources. The study showed that the elements that influenced the process of index testing in Côte d’Ivoire were multifactorial, including individual, interpersonal, health systems, and societal factors. Thus, a multi-faceted approach to overcoming challenges of index testing in Côte d’Ivoire is needed to improve the yield of index testing. Public Library of Science 2023-02-08 /pmc/articles/PMC9907845/ /pubmed/36753518 http://dx.doi.org/10.1371/journal.pone.0280623 Text en © 2023 Mugisha et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mugisha, Nancy
Tirera, Fatoumata
Coulibaly-Kouyate, Naraba
Aguie, William
He, Yao
Kemper, Kathryn
Robinson, Julia
N’Goran, Luc
Tuho, Moïse
Kouyate, Seydou
Doumbia, Yacouba
Gloyd, Stephen
Kone, Ahoua
Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives
title Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives
title_full Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives
title_fullStr Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives
title_full_unstemmed Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives
title_short Implementation process and challenges of index testing in Côte d’Ivoire from healthcare workers’ perspectives
title_sort implementation process and challenges of index testing in côte d’ivoire from healthcare workers’ perspectives
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9907845/
https://www.ncbi.nlm.nih.gov/pubmed/36753518
http://dx.doi.org/10.1371/journal.pone.0280623
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