‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

Abstract

Background: HIV self-testing (HIVST) can improve HIV-testing rates in ‘hard-to-reach’ populations, including men. We explored HIVST perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda. Methods: This was a qualitative study implemented as part of a pilot, cluster-randomized oral HIVST intervention trial among 1,514 pregnant women attending antenatal care services at three health facilities in Central Uganda. The qualitative component of the study was conducted between February and March 2017. We conducted 32 in-depth interviews to document women and men’s perceptions about HIVST, strategies used by women in delivering the kits to their male partners, male partners’ reactions to receiving kits from their female partners, and positive and negative social outcomes post-test. All interviews were audio-recorded, transcribed verbatim, and analyzed manually following a thematic framework approach. Results: Women were initially anxious about their male partners’ reaction if they brought HIVST kits home, but the majority eventually managed to deliver the kits to them successfully. Women who had some level of apprehension used a variety of strategies to deliver the kits including placing the kits in locations that would arouse male partners’ inquisitiveness or waited for ‘opportune’ moments when their husbands were likely to be more receptive. A few (three) women lied about the purpose of the test kit (testing for syphilis and other illnesses) while one woman stealthily took a mucosal swab from the husband. Most men initially doubted the ability of oral HIVST kits to test for HIV, but this did not stop them from using them. Both men and women perceived HIVST as an opportunity to learn about each other’s HIV status. No serious adverse events were reported post-test. Conclusion: Our findings lend further credence to previous findings regarding the feasibility of female-delivered HIVST to improve male partner HIV testing in sub-Saharan Africa. However, support for women in challenging relationships is required to minimize potential for deception and coercion.

Perspectives on HIV partner notification, partner HIV self‐testing and partner home‐based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia

“…When asked about the three HIV testing modalities, concerns were raised by all stakeholders about potential social harms, most commonly relationship conflict and stigmatization. Most trials, however, evaluating antenatal partner testing approaches found few or no social harms . One exception was a passive partner notification evaluation that found the majority of intimate partner violence (IPV) was reported among couples who had received a positive HIV result during couples testing (4/6) .…”

“…To address this issue, women may wish to provide the HIV testing choices to their partner before making the decision and should be counselled on the optimal time, place, and way to communicate the testing options. Trainings that address these issues have been found to be effective for secondary distribution of self‐test kits and partner notification . Additionally, all stakeholder groups noted the importance of women engaging men around key decisions related to each HIV testing option, such as when to schedule the home visit.…”

“…Several evidence‐based practices increase male partner HIV testing in antenatal settings in SSA, including partner notification , home‐based testing and secondary distribution of self‐test kits . These approaches target male partners of HIV‐positive and HIV‐negative pregnant and postpartum women.…”

Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis

“…As a result of the research method used (qualitative or mixed methods), qualitative data from the sixteen included studies were extracted. The included studies were conducted in the following countries: Zambia [24], Malawi [11,25], South Africa [12,[26][27][28][29][30], Tanzania [31][32][33], Uganda [34,35], Zimbabwe and Malawi [36], and Kenya [37]. Twelve studies were predominantly qualitative and four were mixed methods.…”

“…The evidence on acceptability was reported on in nine studies [11,12,25,26,[31][32][33][34]37]. The majority of men showed a willingness to use HIVST in studies conducted in Malawi [11], Tanzania [32,33], South Africa [26], and Kenya [37], with most of the participants having administered HIVST in the past in Tanzania [33].…”