"It is always better for a man to know his HIV status" - A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya
"It is always better for a man to know his HIV status" - A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya
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DOI：
10.1371/journal.pone.0231645
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发表时间：
2020-04-15
期刊：
影响因子：
3.7
通讯作者：
Sarna, Avina
中科院分区：
文献类型：
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作者：
Okal, Jerry;Lango, Daniel;Sarna, Avina
艾滋病毒检测服务是艾滋病毒方案的一个重要组成部分，为新诊断为艾滋病毒感染者提供临床护理的切入点。虽然肯尼亚的艾滋病毒检测率有所提高，但男子接受检测和获得服务的可能性仍然低于妇女。然而，该国男子对艾滋病毒检测的背景、障碍和促进因素的了解有限。数据来自对30名男性艾滋病毒感染者和8名艾滋病毒检测顾问的深入访谈，访谈的目的是深入了解内罗毕市男性艾滋病毒检测的动机和驱动因素。通过检查早期和晚期诊断的临床CD 4登记（例如，CD 4>= 500个细胞/mm 2，早期诊断和< 500个细胞/mm 2，晚期诊断）追溯性地识别男性。分析工作涉及确定广泛的主题，并生成描述性代码和类别。早期检测的时机与强有力的社会支持系统和检测机构有关，而检测费用、检测设施的选择和薄弱的社会支持系统（特别是伙伴间关系不佳）导致检测延迟。在测试之前进行了最少的讨论，只要有对话，就会与伴侣或其他近亲进行对话。在个人，医疗保健系统和人际层面的相互关联的障碍阻碍了获得检测服务。具体而言，测试的障碍包括感知提供者的态度，设施的位置和设置，等待时间/不方便的诊所时间，低风险的认知，有限的艾滋病毒知识，耻辱，歧视和害怕有一个测试。高风险认知、严重疾病、对伴侣状况的认识、保密性、服务和用品的质量、灵活/延长的开放时间以及检测前和检测后咨询都是促进因素。早期和晚期测试者之间的经验重叠，尽管有微小的差异。为了在全国范围内产生预期的影响，实现90-90-90的具体目标，需要采取多重干预措施，解决检测的障碍和促进因素，以增加检测的接受率，并将阳性结果与护理联系起来。
HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of >= 500 cells/mm, early diagnosis and < 500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, healthcare system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/inconvenient clinic times, low perception of risk, limited HIV knowledge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.