Research Article
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Published Online: 1 November 2016

Understanding Barriers to Scaling Up HIV Assisted Partner Services in Kenya

Publication: AIDS Patient Care and STDs
Volume 30, Issue Number 11

Abstract

Assisted partner services (APS) are more effective than passive referral in identifying new cases of HIV in many settings. Understanding the barriers to the uptake of APS in sub-Saharan Africa is important before its scale up. In this qualitative study, we explored client, community, and healthcare worker barriers to APS within a cluster randomized trial of APS in Kenya. We conducted 20 in-depth interviews with clients who declined enrollment in the APS study and 9 focus group discussions with health advisors, HIV testing and counseling (HTC) counselors, and the general HTC client population. Two analysts coded the data using an open coding approach and identified major themes and subthemes. Many participants reported needing more time to process an HIV-positive result before providing partner information. Lack of trust in the HTC counselor led many to fear a breach of confidentiality, which exacerbated the fears of stigma in the community and relationship conflicts. The type of relationship affected the decision to provide partner information, and the lack of understanding of APS at the community level contributed to the discomfort in enrolling in the study. Establishing trust between the client and HTC counselor may increase uptake of APS in Kenya. A client's decision to provide partner information may depend on the type of relationship he or she is in, and alternative methods of disclosure may need to be offered to accommodate different contexts. Spreading awareness about APS in the community may make clients more comfortable providing partner information.

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References

1.
NASCOP. Kenya AIDS Indicator Survey 2012: Final Report. Nairobi: Ministry of Health, Kenya, 2014.
2.
Waruiru W, Kim AA, Kimanga DO, et al. The Kenya AIDS Indicator Survey 2012: Rationale, methods, description of participants, and response rates. J Acquir Immune Defic Syndr 2014;66:S3–S12.
3.
Hogben M, McNally T, McPheeters M, Hutchinson AB. The effectiveness of HIV partner counseling and referral services in increasing identification of HIV-positive individuals: A systematic review. Am J Prev Med 2007;33(2 Suppl.):S89–S100.
4.
CDC. Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. MMWR Morb Mortal Wkly Rep 2008;57:1–63.
5.
Henley C, Forgwei G, Welty T, et al. Scale-up and case-finding effectiveness of an HIV partner services program in Cameroon: An innovative HIV prevention intervention for developing countries. Sex Transm Dis 2013;40:909–914.
6.
Brown LB, Miller WC, Kamanga G, et al. HIV partner notification is effective and feasible in sub-Saharan Africa: Opportunities for HIV treatment and prevention. J Acquir Immune Defic Syndr 2011;56:437–442.
7.
Wamuti BM, Erdman LK, Cherutich P, et al. Assisted partner notification services to augment HIV testing and linkage to care in Kenya: Study protocol for a cluster randomized trial. Implement Sci IS 2015;10:23.
8.
Alam N, Chamot E, Vermund SH, Streatfield K, Kristensen S. Partner notification for sexually transmitted infections in developing countries: A systematic review. BMC Public Health 2010;10:19.
9.
Adams OP, Carter AO, Redwood-Campbell L. Understanding attitudes, barriers and challenges in a small island nation to disease and partner notification for HIV and other sexually transmitted infections: A qualitative study. BMC Public Health 2015;15:455.
10.
Nuwaha F, Faxelid E, Neema S, Eriksson C, Hojer B. Psychosocial determinants for sexual partner referral in Uganda: Qualitative results. Int J STD AIDS 2000;11:156–161.
11.
Netsanet F, Dessie A. Acceptance of referral for partners by clients testing positive for human immunodeficiency virus. HIV AIDS (Auckl) 2013;5:19–28.
12.
Reed JL, Huppert JS, Gillespie GL, et al. Adolescent patient preferences surrounding partner notification and treatment for sexually transmitted infections. Acad Emerg Med 2015;22:61–66.
13.
Wang AL, Peng R-R, Tucker JD, Cohen MS, Chen X-S. Partner notification uptake for sexually transmitted infections in China: A systematic literature review. Sex Transm Infect 2012;88:386–393.
14.
Edelman EJ, Cole CA, Richardson W, Boshnack N, Jenkins H, Rosenthal MS. Opportunities for improving partner notification for HIV: Results from a community-based participatory research study. AIDS Behav 2014;18:1888–1897.
15.
Lyimo RA, Stutterheim SE, Hospers HJ, de Glee T, van der Ven A, de Bruin M. Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania. AIDS Patient Care STDS 2014;28:98–105.
16.
Sabidó M, Gregg LP, Vallès X, et al. Notification for sexually transmitted infections and HIV among sex workers in Guatemala: Acceptability, barriers, and preferences. Sex Transm Dis 2012;39:504–508.

Information & Authors

Information

Published In

cover image AIDS Patient Care and STDs
AIDS Patient Care and STDs
Volume 30Issue Number 11November 2016
Pages: 506 - 511
PubMed: 27849369

History

Published in print: November 2016
Published online: 1 November 2016

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    Authors

    Affiliations

    Marielle Goyette
    Department of Epidemiology, University of Washington, Seattle, Washington.
    Beatrice Muthoni Wamuti
    Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
    Mercy Owuor
    Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
    David Bukusi
    Department of Voluntary Counseling and Testing (VCT) and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya.
    Peter Mutiti Maingi
    Department of Voluntary Counseling and Testing (VCT) and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya.
    Felix Abuna Otieno
    Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
    Peter Cherutich
    National AIDS & STI Control Program (NASCOP), Kenya Ministry of Health, Nairobi, Kenya.
    Anne Ng'ang'a
    National AIDS & STI Control Program (NASCOP), Kenya Ministry of Health, Nairobi, Kenya.
    Carey Farquhar
    Department of Epidemiology, University of Washington, Seattle, Washington.
    Department of Medicine, University of Washington, Seattle, Washington.
    Department of Global Health, University of Washington, Seattle, Washington.

    Notes

    Address correspondence to:Marielle Goyette, MPHDepartment of EpidemiologyUniversity of WashingtonBox 357236Seattle, WA 98195E-mail: [email protected]

    Authors' Contributions

    C.F., P.C., D.B., A.N., and B.M.W. developed and implemented the APS trial protocol. B.M.W., M.G., and C.F. designed the qualitative study. B.M.W., P.M.M., D.B., A.N., and C.F. created the interview and FGD guides. B.M.W. and F.A.O. coordinated data collection. M.O. conducted participant interviews and focus groups, and M.O. transcribed and translated the data. M.G. and M.O. analyzed the data, and M.G. drafted the article. All authors contributed to editing of the article and approved submission of the final draft for publication.

    Author Disclosure Statement

    No competing financial interests exist.

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