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HIV testing experiences and their implications for patient engagement with HIV care and treatment on the eve of 'test and treat': findings from a multicountry qualitative study

HIV testing experiences and their implications for patient engagement with HIV care and treatment on the eve of 'test and treat': findings from a multicountry qualitative study
HIV testing experiences and their implications for patient engagement with HIV care and treatment on the eve of 'test and treat': findings from a multicountry qualitative study

OBJECTIVE: In view of expanding 'test and treat' initiatives, we sought to elicit how the experience of HIV testing influenced subsequent engagement in HIV care among people diagnosed with HIV.

METHODS: As part of a multisite qualitative study, we conducted in-depth interviews in Uganda, South Africa, Tanzania, Kenya, Malawi and Zimbabwe with 5-10 health workers and 28-59 people living with HIV, per country. Topic guides covered patient and provider experiences of HIV testing and treatment services. Themes were derived through deductive and inductive coding.

RESULTS: Various practices and techniques were employed by health workers to increase HIV testing uptake in line with national policies, some of which affected patients' subsequent engagement with HIV services. Provider-initiated testing was generally appreciated, but rarely considered voluntary, with instances of coercion and testing without consent, which could lead to disengagement from care.Conflicting rationalities for HIV testing between health workers and their clients caused tensions that undermined engagement in HIV care among people living with HIV. Although many health workers helped clients to accept their diagnosis and engage in care, some delivered static, morally charged messages regarding sexual behaviours and expectations of clinic use which discouraged future care seeking. Repeat testing was commonly reported, reflecting patients' doubts over the accuracy of prior results and beliefs that antiretroviral therapy may cure HIV. Repeat testing provided an opportunity to develop familiarity with clinical procedures, address concerns about HIV services and build trust with health workers.

CONCLUSION: The principles of consent and confidentiality that should underlie HIV testing and counselling practices may be modified or omitted by health workers to achieve perceived public health benefits and policy expectations. While such actions can increase HIV testing rates, they may also jeopardise efforts to connect people diagnosed with HIV to long-term care, and undermine the potential of test and treat interventions.

Journal Article
1368-4973
Wringe, Alison
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Moshabela, Mosa
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Nyamukapa, Constance
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Bukenya, Dominic
cfe08bb0-b75b-4d17-94c4-f90309e40e34
Ondenge, Ken
af61e331-b34f-4f2a-b6d4-0423869cd98b
Ddaaki, William
57246cbf-1dc8-45f6-9131-2c1c3572c70d
Wamoyi, Joyce
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Seeley, Janet
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Church, Kathryn
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Zaba, Basia
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Hosegood, Victoria
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Bonnington, Oliver
dba93617-8517-404e-9a51-ba2674b1edfc
Skovdal, Morten
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Renju, Jenny
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Wringe, Alison
616301a6-4d77-4067-acd9-4eecfc6e47ac
Moshabela, Mosa
c33cf920-3319-4aab-a3ee-1e09291afaa1
Nyamukapa, Constance
3222cb49-f056-436c-b817-4db0f3932714
Bukenya, Dominic
cfe08bb0-b75b-4d17-94c4-f90309e40e34
Ondenge, Ken
af61e331-b34f-4f2a-b6d4-0423869cd98b
Ddaaki, William
57246cbf-1dc8-45f6-9131-2c1c3572c70d
Wamoyi, Joyce
09e1331b-bbc3-4e34-ae4d-dd21cb41c76d
Seeley, Janet
d054fcce-891e-492e-855e-ccdb122dc120
Church, Kathryn
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Zaba, Basia
e5d3b7e2-e51a-4b2d-a6cd-c90d152623f0
Hosegood, Victoria
c59a89d5-5edc-42dd-b282-f44458fd2993
Bonnington, Oliver
dba93617-8517-404e-9a51-ba2674b1edfc
Skovdal, Morten
2a44be7e-5a06-432e-a4d6-feb57b74bf9c
Renju, Jenny
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Wringe, Alison, Moshabela, Mosa, Nyamukapa, Constance, Bukenya, Dominic, Ondenge, Ken, Ddaaki, William, Wamoyi, Joyce, Seeley, Janet, Church, Kathryn, Zaba, Basia, Hosegood, Victoria, Bonnington, Oliver, Skovdal, Morten and Renju, Jenny (2017) HIV testing experiences and their implications for patient engagement with HIV care and treatment on the eve of 'test and treat': findings from a multicountry qualitative study. Sexually Transmitted Infections, 93 (Suppl 3), [e052969]. (doi:10.1136/sextrans-2016-052969).

Record type: Article

Abstract

OBJECTIVE: In view of expanding 'test and treat' initiatives, we sought to elicit how the experience of HIV testing influenced subsequent engagement in HIV care among people diagnosed with HIV.

METHODS: As part of a multisite qualitative study, we conducted in-depth interviews in Uganda, South Africa, Tanzania, Kenya, Malawi and Zimbabwe with 5-10 health workers and 28-59 people living with HIV, per country. Topic guides covered patient and provider experiences of HIV testing and treatment services. Themes were derived through deductive and inductive coding.

RESULTS: Various practices and techniques were employed by health workers to increase HIV testing uptake in line with national policies, some of which affected patients' subsequent engagement with HIV services. Provider-initiated testing was generally appreciated, but rarely considered voluntary, with instances of coercion and testing without consent, which could lead to disengagement from care.Conflicting rationalities for HIV testing between health workers and their clients caused tensions that undermined engagement in HIV care among people living with HIV. Although many health workers helped clients to accept their diagnosis and engage in care, some delivered static, morally charged messages regarding sexual behaviours and expectations of clinic use which discouraged future care seeking. Repeat testing was commonly reported, reflecting patients' doubts over the accuracy of prior results and beliefs that antiretroviral therapy may cure HIV. Repeat testing provided an opportunity to develop familiarity with clinical procedures, address concerns about HIV services and build trust with health workers.

CONCLUSION: The principles of consent and confidentiality that should underlie HIV testing and counselling practices may be modified or omitted by health workers to achieve perceived public health benefits and policy expectations. While such actions can increase HIV testing rates, they may also jeopardise efforts to connect people diagnosed with HIV to long-term care, and undermine the potential of test and treat interventions.

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More information

Accepted/In Press date: 20 May 2017
e-pub ahead of print date: 23 July 2017
Published date: July 2017
Additional Information: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: Journal Article

Identifiers

Local EPrints ID: 413990
URI: http://eprints.soton.ac.uk/id/eprint/413990
ISSN: 1368-4973
PURE UUID: 4efcc50b-a3bc-48b9-98a2-63f53829ae01
ORCID for Victoria Hosegood: ORCID iD orcid.org/0000-0002-2244-2518

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Date deposited: 12 Sep 2017 16:31
Last modified: 17 Dec 2019 01:40

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