“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

Abstract

Background: HIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. The objective of this study is to identify community-based strategies to increase testing among African Americans in both urban and rural areas. Methods: This study conducted focus group discussions (FGDs) informed by community-based participatory research principles to examine African American's concerns and ideas around HIV testing and HIV self-testing. Participants included highly affected (i.e., PLWH, MSM, PWID, low-income, teens and young adults) populations from African American communities in North Carolina, aged 15 years and older. We digitally transcribed and analyzed qualitative data using MAXQDA and axial coding to identify emergent themes.Results: Fifty-two men and women between 15 to 60 years old living in urban (n=41) and rural (n=11) areas of North Carolina participated in focus group discussions. HIV testing barriers differed by HIV testing setting: facilitybased, community-based, and HIV self-testing. In community-based settings, barriers included confidentiality concerns. In facility-based settings (e.g., clinics), barriers included negative treatment by healthcare workers. With HIV self-testing, barriers included improper use of self-testing kits and lack of post-test support. HIV testing facilitators included partnering with community leaders, decentralizing testing beyond facility-based sites, and protecting confidentiality.(Continued on next page)

Preparing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Self-Testing Implementation: Lessons Learned From HIV Self-Testing

“…As is the case with HIV, Black communities are disproportionately affected by . This population has experienced extensive barriers to facility-based HIV testing and HIVST (35) and the pattern seems to be repeating for COVID-19. We need novel ways to ensure the most vulnerable populations, who are also the most likely to be infected with and die from COVID-19, have access to affordable SARS-CoV-2ST.…”

“…As a result from these studies, the World Health Organization (WHO) now recommends HIVST as one of the testing strategies for HIV prevention efforts (30). These studies, including our own (31)(32)(33)(34)(35)(36)(37)(38)(39), have provided evidence on different distribution strategies from online platforms, peers to sexual partners, community health workers (40)(41)(42). Similarly, these studies have assessed different approaches to verify HIVST results either through direct supervision by health provider, requesting participants to return used HIVST kits, electronic transmission of photographs, or using Bluetooth sensors (43).…”

Impact of the COVID-19 Pandemic on HIV Care Continuum in Jiangsu, China

“…HIV self-testing is an innovative approach to merging the gap between key population and public health facilities as well as providing access to HIV testing safely by maintaining social distancing. In addition, the convenience and privacy associated with HIV self-testing can help expand the coverage of HIV testing and reach those who are reluctant, or unable to access facility-based HIV testing [28,29]. Following the procedure for HIV testing in China, the duration between time of screening test and con rmatory testing can be reduced by use of "one-stop service" centers [30].…”

A Community Health Worker Approach for Ending the HIV Epidemic

“…Through those relationships, CHWs serve as a critical link between marginalized populations and healthcare resources. 10,12 By effectively engaging medically underserved communities, CHWs contribute to improved health outcomes and reductions in health disparities. 2,4,13 The stigma and fear associated with HIV infection and pervasive mistrust of the healthcare system are also diminished by the earned credibility of CHWs, who often may be members of the prioritized populations themselves.…”