Reaching hard-to-reach men through home-based couple HIV testing among pregnant women and their male partners in Western Kenya: A qualitative study

Abstract

Background Globally only 79% of HIV positive adults know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach population for HIV testing. Home-based HIV couple testing during the antenatal period is a safe and effective method that has been used to test male partners of pregnant women. The goal of this qualitative study was to identify elements that made couple testing successful and describe important characteristics of this home-based intervention from couples’ perspectives. Methods Couples who received scheduled home-based couple testing during pregnancy in Kisumu, Kenya, were purposively sampled based on HIV status from January to May 2015. An interviewer administered all of the in-depth interviews and two coders were directly involved in the data analysis and reconciled codes several times in the process. Results Twenty-one couples were enrolled: 9 concordant HIV-negative couples, 8 HIV discordant couples, 3 HIV concordant HIV-positive couples, and 1 whose concordance status was unknown. Median age at the time of home-based couple testing was 24 and 28 years for women and men, respectively. Median relationship duration was 3 years and couples had a median of two pregnancies. The major themes that emerged were that home-based couple testing 1) removed the female burden of requesting couple testing, 2) overcame logistical barriers associated with clinic-based testing, 3) encouraged participants to overcome their fear of testing and disclosure, 4) was preferred due to privacy in the home, and 5) provided quality time with the health advisors. Importantly, some women appreciated individual testing at the clinic before couple testing and some couples preferred skilled, anonymous health advisors delivering the intervention rather than known community health workers. Conclusions The results of this qualitative study suggest that home-based couple testing during pregnancy overcame many of the barriers that limit men’s access to and uptake of clinic-based testing. It encouraged participants to overcome their fear of testing and disclosure through a setting that afforded privacy and quality time with skilled health advisors. These qualitative results may help design effective partner and couple HIV testing programs in the antenatal setting and alongside or within other assisted partner notification services.

The use of home-based HIV testing and counseling in low-and-middle income countries: a scoping review

“…Of these, two studies were conducted at a semi-urban setting [31, 48], 10 in rural settings [32, 34–36, 39–42, 46, 47] and five studies did not specify their setting [33, 38, 44, 45, 49]. Of the included studies, three were conducted in south Africa [32, 41, 46], five in Kenya [35, 36, 42, 44, 45], two in Uganda [43, 49], two in Malawi [31, 33], one each in Zambia [34], Botswana [47], Ethiopia [39], Pakistan [38] and Swaziland [40]. All included studies were published between the year 2013 and 2017.…”

“…All included studies reported evidence on the use of home-based HTC in LMICs. The included studies used the following study designs: one was a qualitative study [43]; eight were randomized control trials [32, 34, 39, 42, 44–47], five were cross-sectional studies [31, 35, 36, 38, 40]; two were systematic reviews [41, 49], and one cohort studies [33].…”

“…Of the 17 included studies, two study reported on couples home-based HTC [31, 38], one study reported on community-based HTC for Prevention of Mother-to-Child Transmission (PMTCT) [35], one study reported on family-based HTC [41], three studies reported on home-based HTC on pregnant women and their partners [36, 44, 45], five studies reported on the effects of home-based HTC intervention [32, 34, 39, 42, 47]. Of the 17 included studies, seven reported usage of home-based HTC in LMICs [31, 35, 36, 38, 44, 45, 50]. Four studies reported about feasibility of home-based HTC [40, 43, 46, 50].…”

“…Three studies reported evidence on the use of home-based HTC on pregnant women and their partners [36, 44, 45]. Krakowiak et al, 2015 conducted a study on home-based HTC among male partners of expectant mothers aimed at assessing its effectiveness in Kenya [44].…”

“…Three studies reported evidence on the use of home-based HTC on pregnant women and their partners [36, 44, 45]. Krakowiak et al, 2015 conducted a study on home-based HTC among male partners of expectant mothers aimed at assessing its effectiveness in Kenya [44]. The study showed evidence that home-based HTC improved substantially the uptake of HIV testing among male partners of expectant mothers, improved HIV status disclosure between couples, and increased sero-discordant partner identification [36, 44].…”