Barriers to accessibility and utilization of HIV testing and counseling services in Tanzania: experience from Angaza Zaidi programme

Meremo, Alfred; Mboya, Beati Alphonce; Ngilangwa, David Paul; Dulle, Robert; Tarimo, Edith A. M.; Urassa, David P.; Michael, Emillian; Gibore, Nyasiro S; Mpondo, Bonaventura C. T.; Mchonde, Gabriel J.; Ernest, Alex; Noronha, Rita; Ilako, Festus

doi:10.11604/pamj.2016.23.189.5683

Cited by 17 publications

(17 citation statements)

References 12 publications

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“…Selection of facilities based on the number of clients accessing HTS and geographical location was done to try and determine whether access to services by men is enhanced or impeded the facilities client load and location. Existing literature has documented stigma and discrimination, confidentiality and long wait time as barriers to HTS services [14,19,27]. We conducted a mapping and scoping of health facilities providing HTS services in Nairobi County.…”

Section: Methodsmentioning

confidence: 99%

“…Existing evidence suggests a variety of possible barriers to uptake of HIV testing among men in SSA including individual/ personal factors such as gender norms [26], fear of results [16][17][18], stigma and discrimination [14,19], low perception of risk [2,15,20], and fear of disclosure. Facility-related factors such as provider attitude and (lack of) confidentiality [27], inadequate supplies and equipment [28] have been documented to hinder access to testing services [29,30]. Diverse structural factors such as sub-optimal targeting, inadequate public information have also been noted to obstruct access to HIV testing [28].…”

Section: Introductionmentioning

confidence: 99%

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“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

et al. 2020

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HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of �500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, healthcare system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/ inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

et al. 2020

View full text Add to dashboard Cite

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“…Since most new HIV infections are caused by persons unaware of their HIV sero-status [5,6], HIV testing is a crucial step for getting people into prevention, care and treatment services. A variety of approaches have been employed to deliver HIV testing services (HTS) including; integrating HTS into family planning or antenatal care services [7], outpatient services [8][9][10] and the use of communitybased testing [9,[11][12][13][14][15][16]. Also, a multitude of community-based HTS approaches such as mobile services in Benin [17], mapping in South Africa [18] and drop-in centres in the Democratic Republic of Congo [19] have explicitly been designed to increase uptake among FSWs.…”

Section: Introductionmentioning

confidence: 99%

Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

Nnko

Nyato

Kuringe

et al. 2019

Preprint

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Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania.Methods: We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software.Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST.Results: A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants' support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants' perception that HIVST would be provided only through unassisted modality.Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available.Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

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“…Only 39% of men and 63% of women (aged 15-24 years) who had had sexual intercourse within 12 months preceding the survey reported having been tested for HIV [2]. Concerns about con dentiality and privacy were the key barriers to HTS among young people [26]. Another national survey in 2016 showed that HIV positive young people were less likely to have undergone HIV testing and the average HTS coverage was 52% [27].…”

Section: Introductionmentioning

confidence: 99%

Bridging the science-to-service gap: Implementation of a supervised HIV self-testing intervention among young adults at a tertiary education institution in Zimbabwe

Mukora-Mutseyekwa

Mundagowa

Kangwende³

et al. 2020

Preprint

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Background The evidence-based practices of implementation science constitute the integration of study findings into routine practice of public health interventions such as HIV testing services (HTS). While young people are at high risk of HIV infection, a national survey showed that adolescents and youths were less likely to go for an HIV test. This study aimed to develop and implement a systematic and multifaceted HIV self-testing (HIVST) intervention to promote the uptake of HTS among young people.Methods The study was conducted at Africa University, Mutare where desk and literature review was conducted to gather evidence on HIVST. Multiple stakeholder consultation was carried out to understand contextual enablers and barriers that either promote or undermine adoption of the intervention. Strategies for situation analysis and evidence gathering included community engagement meetings, training of implementers and conducting a baseline survey. A consensus group adapted the Consolidated Framework for Implementation Research (CFIR) to understand the realities of context and intervention while the Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) guide was used to analyze the intervention implementation and evaluation survey.Results The baseline enquiry indicated that the CFIR dimensions which positively influences intervention implementation were: network, network and communications, preparation of implementation, availability of resources, planification, implication and formally appointed internal leadership while origin of intervention and self-efficacy had negatively influenced implementation. Evaluating the intervention fidelity using the RE-AIM framework revealed that high performance with regard to reach, effectiveness, adoption and implementation but low maintenance. This study also applied the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects, and equity) for selecting the final components used in implementation.Conclusion Combining literature search, documents review, stakeholder consultation, together with provider and end-user engagement can potentially improve intervention delivery for closed populations such as Universities. Blending program agents with systematic process of activities correspondingly enhance HTS uptake among young people. The utilization of the CFIR and RE-AIM analytical frameworks in this study, offered flexible and simplified implementation and analysis of the intervention.

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Barriers to accessibility and utilization of HIV testing and counseling services in Tanzania: experience from Angaza Zaidi programme

Cited by 17 publications

References 12 publications

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

“It is always better for a man to know his HIV status” – A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya

Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

Bridging the science-to-service gap: Implementation of a supervised HIV self-testing intervention among young adults at a tertiary education institution in Zimbabwe

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