Recruiting the social contacts of patients with STI for HIV screening in Lilongwe, Malawi: process evaluation and assessment of acceptability

Abstract

Objectives To explore acceptability of recruiting social contacts for HIV and STI screening in Lilongwe, Malawi. Methods In this observational study, three groups of “seed” patients were enrolled: 45 HIV-infected STI patients, 45 HIV-uninfected STI patients, and 45 community controls, who were also tested for HIV as part of the study. Each seed was given five coupons and asked to recruit up to five social contacts to the STI clinic. Seeds were told the programme for contacts would include HIV testing, STI screening, and general health promotion. Seeds were asked to return after one month to report on the contact recruitment process. Seeds received $2 for each successfully recruited contact. Results Eighty-nine seeds (66%) returned for one-month follow-up with no difference between the three seed groups (p=0.9). Returning seeds reported distributing most of their coupons (mean=4.1) and discussing each feature of the programme with most contacts—HIV testing (90%), STI screening (87%), and health promotion (91%). Seeds reported discussing their own HIV status with most contacts (52%), with a lower proportion of HIV-infected seeds discussing their HIV status (22%) than HIV-uninfected seeds (81%) or community seeds (64%) (p<0.001). Contact recruitment did not vary with socioeconomic status. Conclusions Most seeds distributed all coupons and reported describing all aspects of the programme to most contacts. STI patients are able to act as health promoters within their social networks and may be a critical link to increasing STI and HIV status awareness among high risk groups.

A Systematic Review of HIV Testing Implementation Strategies in Sub-Saharan African Countries

“…In addition to privacy concerns, low risk perception, needing partner permission and time constraints, declining a test was associated with fear of stigma and intimate partner violence [16,18,82,96,111,112]. This indicates the need for HIV awareness campaigns to reduce stigma and intimate partner violence associated with HIV-positive status and also promote autonomy among women [18,56,113]. Couples oriented counseling should be provided in antenatal clinics and incorporated in family planning services to empower women to share test results with partners in a safe environment to mitigate intimate partner violence [79].…”

Improving STI and HIV Passive Partner Notification Using the Model for Improvement: A Quality Improvement Study in Lilongwe Malawi

“…Incentives have been used by many researchers and program implementers to improve outcomes [ 20 – 24 ]. Conditional or unconditional, monetary or non-monetary incentives have led to increased contact notification [ 25 ], increased HIV testing [ 20 ], increased retention in HIV care [ 24 ], increased condom use and safe sex behaviour, and reduced unwanted pregnancies and HIV acquisition [ 22 ]. Experts perceived expeditious partner visits as the best non-monetary incentive for sexual partners/couples.…”