Brief Report: "Give Me Some Time": Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda.
Brief Report: "Give Me Some Time": Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda.
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DOI：
10.1097/qai.0000000000001617
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发表时间：
2018-04-01
期刊：
影响因子：
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通讯作者：
Davis JL
中科院分区：
文献类型：
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作者：
Armstrong-Hough M;Ggita J;Ayakaka I;Dowdy D;Cattamanchi A;Haberer JE;Katamba A;Davis JL
将家庭艾滋病毒咨询和检测 (HCT) 与结核病 (TB) 评估相结合，可以提高活动性结核病患者的家庭接触者对艾滋病毒检测的接受度。我们在乌干达坎帕拉的结核病家庭接触者调查中试图找出 HCT 的促进因素和障碍。我们对 28 名家庭接触者进行了嵌套式半结构化访谈，他们在一项针对结核病接触者调查家庭策略的家庭随机试验中接受了家庭 HCT。受访者反思了他们的家访经历、家庭的社会背景以及他们接受或拒绝艾滋病毒检测的决定。我们使用内容分析来识别和评估测试的促进因素和障碍，然后使用能力、机会、动机和行为 (COM-B) 模型对出现的主题进行分类。促进者包括预先存在的愿望，即确认艾滋病毒状况或对指示结核病患者表示支持；认为家庭服务很方便；以及非专业卫生工作者的积极看法。主要障碍包括对结果的恐惧以及在心理上没有准备好接受结果。其他家庭成员的社会影响既是促进者也是障碍。预先存在的动机、测试的心理准备以及家庭的社会背景是决定在家进行艾滋病毒检测的主要因素。通过在就诊前提供有关 HCT 的规范化信息、提供第二次 HCT 机会、提供自我测试和后续咨询或使用“选择退出”语言介绍 HCT，可以提高采用率。
Integrating home-based HIV counseling and testing (HCT) with tuberculosis (TB) evaluation could improve uptake of HIV testing among household contacts of patients with active TB. We sought to identify the facilitators of and barriers to HCT during household contact investigation for TB in Kampala, Uganda. We nested semi-structured interviews with 28 household contacts who were offered home-based HCT in a household-randomized trial of home-based strategies for TB contact investigation. Respondents reflected on their experiences of the home visit, the social context of the household, and their decision to accept or decline HIV testing. We used content analysis to identify and evaluate facilitators and barriers to testing, then categorized the emergent themes using the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Facilitators included a pre-existing desire to confirm HIV status or to show support for the index TB patient; a perception that home-based services are convenient; and positive perceptions of lay health workers. Key barriers included fear of results and feeling psychologically unprepared to receive results. The social influence of other household members operated as both a facilitator and a barrier. Pre-existing motivation, psychological readiness to test, and the social context of the household are major contributors to the decision to test for HIV at home. Uptake might be improved by providing normalizing information about HCT prior to the visit, by offering a second HCT opportunity, by offering self-tests with follow-up counseling, or by introducing HCT using “opt-out” language.