Understanding Barriers to Scaling Up HIV Assisted Partner Services in Kenya

Abstract

Assisted partner services (APS) are more effective than passive referral in identifying new cases of HIV in many settings. Understanding the barriers to the uptake of APS in sub-Saharan Africa is important before its scale up. In this qualitative study, we explored client, community, and healthcare worker barriers to APS within a cluster randomized trial of APS in Kenya. We conducted 20 in-depth interviews with clients who declined enrollment in the APS study and 9 focus group discussions with health advisors, HIV testing and counseling (HTC) counselors, and the general HTC client population. Two analysts coded the data using an open coding approach and identified major themes and subthemes. Many participants reported needing more time to process an HIV-positive result before providing partner information. Lack of trust in the HTC counselor led many to fear a breach of confidentiality, which exacerbated the fears of stigma in the community and relationship conflicts. The type of relationship affected the decision to provide partner information, and the lack of understanding of APS at the community level contributed to the discomfort in enrolling in the study. Establishing trust between the client and HTC counselor may increase uptake of APS in Kenya. A client's decision to provide partner information may depend on the type of relationship he or she is in, and alternative methods of disclosure may need to be offered to accommodate different contexts. Spreading awareness about APS in the community may make clients more comfortable providing partner information.

Integrating PrEPintoHIVcare clinics could improve partner testing services and reinforce mutual support among couples: provider views from a PrEPimplementation project in Kenya

“…Despite the observed successes of PNS, the study highlighted challenges, consistent with other studies. The barriers to uptake of partner testing have included mistrust of public health workers, stigma and shame of knowing that they have been diagnosed with HIV and fear of notifying their partners . The study further showed that some partners expressed concerns about confidentiality and stigma.…”

Assisted partner notification services for patients receiving HIV care and treatment in an HIV clinic in Nairobi, Kenya: a qualitative assessment of barriers and opportunities for scale‐up

“…Goyette, et al. conducted a qualitative study of barriers to aPNS in 2016 , which found that many people were still grappling with their own diagnosis and mentioned that they were “shocked,” “in denial,” and “did not want to talk to anyone” after learning of their diagnosis. None of the participants in our study appeared to be struggling with accepting their own diagnosis, and none mentioned reactions such as these.…”

“…There are numerous barriers to undergoing HTS , including fear, lack of knowledge, perception of risk, relationship attributes, healthcare system characteristics and testing location . Similarly, while uptake of aPNS among newly diagnosed clients is generally high , those that refuse may do so due to a need for time to process the diagnosis, lack of trust in healthcare workers (HCWs), and misunderstanding of the process of aPNS . However, very few studies have explored barriers or opportunities for aPNS among PLHIV who are established patients at a CCC, although these individuals refuse aPNS more frequently and may have very different experiences of aPNS than those who are newly diagnosed.…”

Assisted HIV partner services training in three sub‐Saharan African countries: facilitators and barriers to sustainable approaches

“…Key topics covered in training include the core principles of aPS—elicitation of sexual partners, partner tracing and testing, and linkage‐to‐care—counselling and communication skills, managing resistance to partner notification and screening and monitoring intimate partner violence (IPV). The training curricula in these countries highlight the importance of effective communication and building rapport in a provider‐patient relationship to address client barriers to accepting aPS, including lack of trust in HCWs and fear of IPV, breaches in confidentiality and relationship dissolution . Trainees are taught the importance of maintaining confidentiality of clients’ information and how to successfully provide patient‐centred care—critical components in improving client cooperation in aPS activities.…”

“…Currently, community awareness of aPS is low in Cameroon, Kenya and Mozambique, which poses challenges in increasing acceptability of aPS programmes in the populations served. Despite the perceived benefits, many patients show discomfort in providing information about their sexual partners for fear of breach of confidentiality, stigma and relationship conflicts . Community sensitization of aPS through nationwide campaigns could help generate demand and public interest, which could potentially lead to increased funding and resources.…”