Opt-in HIV testing in construction workplaces: an exploration of its suitability, using the socioecological framework

Abstract

Background Late diagnosis of HIV remains a challenge, despite improved testing and treatment. Testing is often targeted at high-risk groups; workplace events might normalise testing and allow access to a wider population. The construction workforce has a number of risk factors for HIV. In the Test@Work study, HIV tests were delivered within general health checks to construction employees, with high uptake and acceptability. This paper reports on the experiences of construction managers and health professionals involved in Test@Work and explores the suitability of construction worksites as a venue for opt-in HIV testing. Methods Qualitative interviews (n = 24) were conducted with construction managers who had facilitated health check/HIV testing (n = 13), and delivery partners (n = 11) including i) healthcare volunteers who had delivered general health checks (n = 7) and, ii) HIV professionals who had conducted HIV testing (n = 4) at 21 Test@Work events held on construction sites. Interviews explored their experiences of these events and views towards HIV testing in the workplace. Exit questionnaires (n = 107) were completed by delivery partners after every event, providing qualitative data identifying facilitators and barriers to effective delivery. Thematic analysis identified themes that were mapped against a socioecological framework. Results Delivery partners reported high engagement of construction workers with workplace HIV testing, peer-to-peer encouragement for uptake, and value for accessibility of onsite testing. HIV professionals valued the opportunity to reach an untested population, many of whom had a poor understanding of their exposure to HIV risk. Managers valued the opportunity to offer workplace health checks to employees but some identified challenges with event planning, or provision of private facilities. Conclusions The construction sector is complex with a largely male workforce. Providing worksite HIV testing and education to an untested population who have poor knowledge about HIV risk helped to normalise testing, encourage uptake and reduce HIV-related stigma. However, there are practical barriers to testing in the construction environment. Rapid testing may not be the most suitable approach given the challenges of maintaining confidentiality on construction worksites and alternatives should be explored.

Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era

“…Routine HIV testing in non-traditional settings can prevent individuals from feeling targeted or judged, help to diagnose those with HIV who are not in an at-risk group, and more broadly help to tackle stigma. 47 For example, The Test@Work programme provided general health checks with optional HIV testing at UK construction worksites, resulting in a high uptake of opt-in HIV testing. 47 Other non-traditional settings may include prisons, pharmacies, termination clinics, and addiction and substance misuse services.…”

“… 47 For example, The Test@Work programme provided general health checks with optional HIV testing at UK construction worksites, resulting in a high uptake of opt-in HIV testing. 47 Other non-traditional settings may include prisons, pharmacies, termination clinics, and addiction and substance misuse services. 48 Dedicated community work can improve testing among minority groups who are not engaged with formal healthcare services; for example, the Naz Project London employed one Latin American community worker to discuss HIV and offer free HIV tests within his network, resulting in 26 new diagnoses in 18 months.…”

Feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing intervention among men in two Ugandan fishing communities

“…Also, men tend to have limited HIV testing opportunities than women who can access HIV testing services through antenatal care or prevention of mother-to-child transmission of HIV services [8,9]. Collectively, these ndings call for a need to implement innovative approaches that can reach men in settings where they work or live [7,10]. These interventions, offered outside formal health facilities, have the potential to not only improve HIV testing uptake but also eventual linkage to HIV care particularly in sub-Saharan Africa [11].…”