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Social response to the delivery of HIV self-testing in households: experiences from four Zambian HPTN 071 (PopART) urban communities
- Source :
- AIDS Research and Therapy, Vol 17, Iss 1, Pp 1-12 (2020), AIDS Research and Therapy
- Publication Year :
- 2019
-
Abstract
- Background Door-to-door distribution of HIV self-testing kits (HIVST) has the potential to increase uptake of HIV testing services (HTS). However, very few studies have explored the social response to and implications of door-to-door including secondary distribution of HIVST on household relations and the ability of individuals to self-test with or without supervision within households. Methods A CRT of HIVST distribution was nested within the HPTN 071 (PopART) trial, in four Zambian communities randomised to receive the PopART intervention. The nested HIVST trial aimed to increase knowledge of HIV status at population level. Between February 1 and April 30, 2017, 66 zones (clusters) within these four communities were randomly allocated to either the PopART standard of care door-to-door HTS (33 clusters) or PopART standard of care door-to-door HTS plus oral HIVST (33 clusters). In clusters randomised to HIVST, trained Community HIV care provider (CHiPs) visited households and offered individuals aged ≥ 16 and eligible for an offer of HTS the choice of HIV testing using HIVST or routine door-to-door HTS (finger-prick RDT). To document participants’ experiences with HIVST, Interviews (n = 40), observations (n = 22) and group discussions (n = 91) with household members and CHiPs were conducted. Data were coded using Atlas.ti 7 and analysed thematically. Results The usage and storage of HIVST kits was facilitated by familiarity with and trust in CHiPs, the novelty of HIVST, and demonstrations and supervision provided by CHiPs. Door-to-door distribution of HIVST kits was appreciated for being novel, convenient, private, empowering, autonomous and easy-to-use. Literacy and age influenced accurate usage of HIVST kits. The novelty of using oral fluids to test for HIV raised questions, some anxiety and doubts about the accuracy of HIVST. Although HIVST protected participants from experiencing clinic-based stigma, it did not address self-stigma. Within households, HIVST usually strengthened relationships but, amongst couples, there were a few reports of social harms. Conclusion Door-to-door distribution of HIVST as a choice for how to HIV test is appreciated at community level and provides an important testing option in the sub-Saharan context. However, it should be accompanied by counselling to manage social harms and by supporting those testing HIV-positive to link to care.
- Subjects :
- Male
Population level
Urban Population
Social Stigma
HIV self-testing
Human immunodeficiency virus (HIV)
HIV Infections
medicine.disease_cause
Literacy
0302 clinical medicine
Hiv test
Mass Screening
Pharmacology (medical)
030212 general & internal medicine
SUB-SAHARAN AFRICA
POPULATION
Qualitative Research
media_common
Family Characteristics
Community health workers
WOMEN
Infectious Diseases
1107 Immunology
Social harms
Molecular Medicine
TRIAL
Female
0305 other medical science
Life Sciences & Biomedicine
lcsh:Immunologic diseases. Allergy
Adult
medicine.medical_specialty
Adolescent
Anti-HIV Agents
media_common.quotation_subject
Zambia
HPTN 071 (PopART) study team
Hiv testing
03 medical and health sciences
Young Adult
Social response
Virology
medicine
Humans
Science & Technology
030505 public health
Community level
business.industry
Research
CARE
Self-Testing
ACCEPTABILITY
Family medicine
Door -to-door distribution of HIVST
Hiv status
Reagent Kits, Diagnostic
lcsh:RC581-607
business
Delivery of Health Care
Subjects
Details
- ISSN :
- 17426405
- Volume :
- 17
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- AIDS research and therapy
- Accession number :
- edsair.doi.dedup.....b9bb9edd92964d89b149aea577269edb