Integration of assisted partner services within Kenya's national HIV testing services program: A qualitative study.
Integration of assisted partner services within Kenya's national HIV testing services program: A qualitative study.
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DOI：
10.1371/journal.pgph.0001586
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发表时间：
2023
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辅助伴侣服务 (aPS) 增强了性伴侣和新诊断出艾滋病毒感染者之间艾滋病毒病例的发现。 2016年，aPS被纳入肯尼亚国家艾滋病毒检测服务（HTS）计划。我们评估了 aPS 集成到 HTS 的程度、障碍和促进因素。我们对在国家、县、设施和社区层面通过有目的抽样选出的 32 个利益相关者进行了半结构化深度访谈 (IDI)。 IDI 在两个时间点进行，基线为 2018 年 8 月至 9 月在基苏木和 2019 年 1 月至 6 月在霍马湾，后续为 2020 年 5 月至 8 月，以了解 aPS 集成随时间的变化。我们将整合定义为在新干预措施 (aPS) 和现有 HTS 计划之间建立联系。使用主题内容分析来分析数据。我们发现 aPS 集成程度不同，采购/物流方面最高，HTS 提供商招聘/培训方面最低。在基线时，aPS 集成度较低，活动处于入门阶段。在后续行动中，除了在基线和后续行动中注意到的社区意识较低之外，aPS 几乎被整合到整个 HTS 计划中。随着明确的 aPS 周期的建立，例行化程度不断提高，例如季度数据审查会议、年度预算周期和工作计划。主要障碍包括有限的政府资金、人员限制和社区层面的宣传不足，而主要的促进因素包括增加 aPS 资源，以及社区卫生志愿者 (CHV) 提高对 aPS 的认识。国家 HTS 计划不同部门之间不同程度的 aPS 整合凸显了资金、人力资源和公众意识方面的挑战。政策制定者需要解决这些障碍，以确保以最佳方式提供 aPS。
Assisted partner service (aPS) augments HIV case-finding among sex partners to individuals newly diagnosed with HIV. In 2016, aPS was incorporated into the national HIV testing services (HTS) program in Kenya. We evaluated the extent of, barriers to, and facilitators of aPS integration into HTS. We conducted semi-structured in-depth interviews (IDIs) with 32 stakeholders selected using purposive sampling at national, county, facility, and community levels. IDIs were conducted at two timepoints, at baseline from August-September 2018 in Kisumu and January-June 2019 in Homa Bay, and at follow-up from May-August 2020 to understand changes in aPS integration over time. We defined integration as the creation of linkages between the new intervention (aPS) and the existing HTS program. Data were analyzed using thematic content analysis. We found varying degrees of aPS integration, highest in procurement/logistics and lowest in HTS provider recruitment/training. At baseline, aPS integration was low and activities were at an introductory phase. At follow-up, aPS was integrated in almost the entire HTS program with the exception of low community awareness, which was noted at both baseline and follow-up. There was increasing routinization with establishment of clear aPS cycles, e.g., quarterly data review meetings, annual budget cycles and work-plans. Major barriers included limited government funding, staff constraints, and inadequate community-level sensitization, while key facilitators included increased resources for aPS, and community health volunteer (CHV) facilitated awareness of aPS. Varying degrees of aPS integration across different units of the national HTS program highlights challenges in funding, human resource, and public awareness. Policymakers will need to address these barriers to ensure optimal provision of aPS.