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Challenges of HIV self-test distribution for index testing when HIV status disclosure is low: preliminary results of a qualitative study in Bamako (Mali) as part of the ATLAS project

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Title: Challenges of HIV self-test distribution for index testing when HIV status disclosure is low: preliminary results of a qualitative study in Bamako (Mali) as part of the ATLAS project
Authors: Boye, S
Bouaré, S
Ky-Zerbo, O
Rouveau, N
Simo Fotso, A
D'Elbée, M
Silhol, R
Maheu-Giroux, M
Vautier, A
Breton, G
Keita, A
Bekelynck, A
Desclaux, A
Larmarange, J
Pourette, D
Item Type: Journal Article
Abstract: Context: The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners. Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis. Results: HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status. Conclusion: It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.
Issue Date: 19-May-2021
Date of Acceptance: 19-Apr-2021
URI: http://hdl.handle.net/10044/1/88905
DOI: 10.3389/fpubh.2021.653543
ISSN: 2296-2565
Publisher: Frontiers Media
Start Page: 1
End Page: 11
Journal / Book Title: Frontiers in Public Health
Volume: 9
Copyright Statement: © 2021 Boye, Bouaré, Ky-Zerbo, Rouveau, Simo Fotso, d'Elbée, Silhol, Maheu-Giroux, Vautier, Breton, Keita, Bekelynck, Desclaux, Larmarange and Pourette. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Sponsor/Funder: Solidarite Therapeutiq Initiative Sida
Funder's Grant Number: N/A
Keywords: 1117 Public Health and Health Services
Publication Status: Published
Article Number: 653543
Online Publication Date: 2021-05-19
Appears in Collections:School of Public Health

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