Drivers and barriers to workplace-based HIV self-testing among high-risk men in Uganda: a qualitative study

Abstract

Background Men in Sub-Saharan Africa are less engaged than women in accessing HIV testing and treatment and, consequently, experience higher HIV-related mortality. Reaching men with HIV testing services is challenging, thus, increasing the need for innovative ways to engage men with low access and those at higher risk. In this study, we explore men’s perceptions of drivers and barriers of workplace-based HIV self-testing in Uganda. Methods An exploratory study involving men working in private security companies employing more than 50 men in two districts, in central and western Uganda. Focus group discussions and key informant interviews were conducted. Data were analyzed using inductive content analysis. Results Forty-eight (48) men from eight private security companies participated in 5 focus group discussions and 17 key informant interviews. Of the 48 men, 14(29.2%) were ages 26–35 years. The majority 31(64.6%) were security guards. The drivers reported for workplace-based HIV self-testing included convenience, autonomy, positive influence from work colleagues, the need for alternative access for HIV testing services, incentives, and involvement of employers. The barriers reported were the prohibitive cost of HIV tests, stigma, lack of testing support, the fear of discrimination and isolation, and concerns around decreased work productivity in the event of a reactive self-test. Conclusions We recommend the involvement of employers in workplace-based HIV self-testing to encourage participation by employees. There is need for HIV self-testing support both during and after the testing process. Both employers and employees recommend the use of non-monetary incentives, and regular training about HIV self-testing to increase the uptake and acceptability of HIV testing services at the workplace.

Health provider perspectives of Village Health Team-delivered oral HIV self-testing among men in Central Uganda: a qualitative evaluation using RE-AIM framework

“…Our ndings are consistent with earlier studies that reported high to moderate linkage to care in HIVST among men [10,11,13,[44][45][46]. However, in other perspectives, researchers have suggested that there may not be a single best approach to boosting men's utilization of HIV linkage services but rather use of combination strategies including home-based ART initiation, use of phone reminders, and communitybased ART initiation [15,42,43,47]. Fluctuations in linkage under HIVST have been attributed to several facilitators including communication modalities, navigating of health facility systems and processes, linkage-and psychosocial support, which may be countered by innumerable barriers such as in exible work schedules, distance to accessing ART, work transfers, denial of HIV-positive results, and fear of stigma and discrimination at health facilities [15].…”

“…Furthermore, this explains why health providers perceived HIVST as a streamlined and trustworthy approach of HIV testing, which can enhance autonomy about one's health. Nonetheless, uptake of HIVST still encounters challenges in novice populations [8], hence attracting the last underserved persons may require a service that appeals to the target population and can intrinsically trigger their involvement in HIV services without prompting of the health providers [42,43]. However, there remains a need for continuous sensitization of the health workers to prioritize support systems for clients who seek facility-based services after HIVST.…”

Barriers and facilitators to oral PrEP uptake among high-risk men after HIV testing at workplaces in Uganda: a qualitative study

“…This agrees with reports that men who consider themselves to be at risk of contracting HIV have shown a high uptake for PrEP [ 40 ]. Previous studies among this population suggest that they fear taking an HIV test because of their sexual behavior and fear of the unknown [ 41 ]. Furthermore, self-perceived risk and risky sexual behaviors are also considered one of the drivers of PrEP uptake in the United States [ 8 , 42 ].…”

Barriers and Facilitators of HIV Self-Testing in Africa: A Qualitative Systematic Review

“…All studies included in this study reported various barriers emanating from individuals that prohibit them from adopting self-HIV testing. For example, there was a prevalence of fear of testing that would lead to negative emotions if found positive especially where there was no pre and post-test counselling, (Agot et al, 2022;Muwanguzi et al, 2021Muwanguzi et al, , 2021Oduetse et al, 2019). Some participants, men working in private security companies in Uganda, observed that being found HIV positive would affect their job performance due to emotional breakdown (Muwanguzi et al, 2021).…”