Linkage to care and treatment among men with reactive HIV self-tests after workplace-based testing in Uganda: A qualitative study

Abstract

IntroductionHIV self-testing at workplaces has the potential to reach men at risk of HIV infection with lower access to HIV testing services. While several studies have reported high uptake of HIV self-testing, linkage to HIV care following a positive result remains a challenge. This study, therefore, explored the motivators for and barriers to linkage to HIV care and treatment among men who returned positive results following workplace-based HIV self-testing.MethodsA qualitative descriptive study, among men in private security services in Kampala district, Uganda. The men were eligible to participate if they were aged 18 to 60 years and had worked at the company for more than 6 months. Following HIV self-testing, participants with reactive (positive) self-test results were purposively sampled and engaged in key informant interviews. Inductive content analysis was employed to identify the motivators and barriers to the men's linkage to HIV treatment and care.ResultsOverall, 12 men participated in the study, of whom 9 (75%) were security guards, and the rest held management positions. The motivators for linkage to care coalesced under five categories. (i) Communication (open communication, phone reminders, consistent communication) (ii) Navigating health facility systems and processes (enabling health facility environment, easy access to health care, employing ART clinic counselors as part of the study team, health workers) (iii) Linkage support (linkage companions, referral forms, linkage facilitation, individualized linkage plan, pre-arranged clinic appointments) (iv) Psychosocial support (counseling sessions, family support, online and social media support, peer support) (v) workplace environment (employer's support, work schedules and policies). The barriers to linkage to HIV care included (i) Inflexible work schedules, (ii) Far distances to travel to access ART (iii) mandatory work transfers, (iv) disruptive effects of the COVID-19 pandemic, (v) Denial of HIV-positive results and (vi) fear of stigma and discrimination at health facilities.ConclusionThe findings suggest the need for innovative interventions to facilitate regular follow-up and open communication with workplace-based HIV self-testers, to improve linkage to HIV care and treatment. Furthermore, initiating linkage plans during pre-test counseling and working in collaboration with health facilities and clinics may improve linkage to care.

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].…”

“…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]. However, VHTs played a vital role in delivering and facilitating oral HIVST, and through the community-based model can continue to conveniently sensitize and guide communities about HIVST, con rmatory testing and other linkage services such as condom use, ART-initiation and re lls, which they may be routinely supporting in their respective communities [44,48,49].…”

Feasibility and Acceptability of Human Immunodeficiency Virus Self-Testing for Men of Middle-to-Upper Socioeconomic Status in Botswana: A Pilot Study at 4 Worksites in the Financial Sector

“…We discovered that it is crucial to further explore stigma-related concerns to determine how to increase testing among men. HIVST among men plays a pivotal role in promoting access to testing, reducing stigma, and ultimately enhancing the overall health outcomes of specific groups affected by HIV [ 56 , 57 ].…”

“We usually see a lot of delay in terms of coming for or seeking care”: an expert consultation on COVID testing and care pathways in low- and middle-income countries

“…As with other RDTs( 16 ) ( 17 ), patients who self-test do not always report their results or promptly seek care. This is also the case for professionally-tested patients with mild disease whose clinical status deteriorates.…”