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Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis

Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis
Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis
Objective: Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal.

Methods: Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18–29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach.

Results: Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake.

Conclusion: Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.
HIV & AIDS, health & safety, public health
2044-6055
Adeagbo, Oluwafemi
1668adf1-8c3a-42cb-af20-da553840bc86
Seeley, Janet
d5de9ac7-b54d-4ea5-9098-0c4456974424
Gumede, Dumsani
1ba43777-25d1-4f52-a6de-dacebc914ae8
Xulu, Sibongiseni
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Dlamini, Nondumiso
7cc7f0ca-7562-473e-84a3-d4c9116caec8
Luthuli, Manono
f6b6d8c4-e814-43f0-ac76-20099eb000ad
Dreyer, Jaco
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Herbst, Carina
1e518f7a-15e3-4efc-9a3a-d890ba212f78
Cowan, Frances
3e404342-5461-4c61-a856-6296c5142c0c
Chimbindi, Natsayi
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Hatzold, Karin
8979970b-e9bc-4630-bb59-a63cdba78916
Okesola, Nonhlanhla
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Johnson, Cheryl
bc19ecf1-af6d-4c3b-aa7e-55c2984a853f
Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Subedar, Hasina
deb6bd5b-e700-496e-847f-ea8a8c997432
Sherr, Lorraine
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Mcgrath, Nuala
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Corbett, Elizabeth L.
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Shahmanesh, Maryam
d88581c9-0ef2-4506-b8d3-d72682936a09
Adeagbo, Oluwafemi
1668adf1-8c3a-42cb-af20-da553840bc86
Seeley, Janet
d5de9ac7-b54d-4ea5-9098-0c4456974424
Gumede, Dumsani
1ba43777-25d1-4f52-a6de-dacebc914ae8
Xulu, Sibongiseni
2a5184fb-ec3a-4e5c-8761-7dc1bf7529bd
Dlamini, Nondumiso
7cc7f0ca-7562-473e-84a3-d4c9116caec8
Luthuli, Manono
f6b6d8c4-e814-43f0-ac76-20099eb000ad
Dreyer, Jaco
66cdb4a4-0837-4f68-bcc0-c903f1e10b9b
Herbst, Carina
1e518f7a-15e3-4efc-9a3a-d890ba212f78
Cowan, Frances
3e404342-5461-4c61-a856-6296c5142c0c
Chimbindi, Natsayi
c518d13f-6c0b-4eb2-92f5-89d260eeba87
Hatzold, Karin
8979970b-e9bc-4630-bb59-a63cdba78916
Okesola, Nonhlanhla
0a55eb44-591c-4c9f-85a1-bd9268d845fc
Johnson, Cheryl
bc19ecf1-af6d-4c3b-aa7e-55c2984a853f
Harling, Guy
0403b83a-0afe-472c-a184-7a6357afe29a
Subedar, Hasina
deb6bd5b-e700-496e-847f-ea8a8c997432
Sherr, Lorraine
dcc07842-49e3-44fc-bf87-d56dd0f15323
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Corbett, Elizabeth L.
57d73b40-1cac-43d4-90ef-23d6d0914e98
Shahmanesh, Maryam
d88581c9-0ef2-4506-b8d3-d72682936a09

Adeagbo, Oluwafemi, Seeley, Janet, Gumede, Dumsani, Xulu, Sibongiseni, Dlamini, Nondumiso, Luthuli, Manono, Dreyer, Jaco, Herbst, Carina, Cowan, Frances, Chimbindi, Natsayi, Hatzold, Karin, Okesola, Nonhlanhla, Johnson, Cheryl, Harling, Guy, Subedar, Hasina, Sherr, Lorraine, Mcgrath, Nuala, Corbett, Elizabeth L. and Shahmanesh, Maryam (2022) Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis. BMJ Open, 12 (2), [e048780]. (doi:10.1136/bmjopen-2021-048780).

Record type: Article

Abstract

Objective: Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal.

Methods: Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18–29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach.

Results: Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake.

Conclusion: Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.

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Accepted/In Press date: 19 January 2022
e-pub ahead of print date: 14 February 2022
Additional Information: Funding This study is part of the Self-Testing Africa (STAR) initiative funded by the Unitaid (grant number: PO#10140-0-600). This research was funded in whole, or in part, by the US National Institute of Health (NIH) R01 (award no: 5R01MH114560-03) and BMGF 3ie that supports a peer led outreach team of navigators to support uptake and retention of adolescents and young adults in existing HIV prevention and by Wellcome Trust Strategic Core award (grant number: 201433/Z/16/A). NM is a recipient of an NIHR Research Professorship award (Ref: RP-2017-08-ST2-008). For the purpose of open access, the author has applied a CC BY public coppyright to any author accepted manuscript version arising from this submission.
Keywords: HIV & AIDS, health & safety, public health

Identifiers

Local EPrints ID: 454849
URI: http://eprints.soton.ac.uk/id/eprint/454849
ISSN: 2044-6055
PURE UUID: d9464ed3-8002-439d-9f52-2180e4b60556
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 25 Feb 2022 17:34
Last modified: 22 Oct 2022 01:43

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Contributors

Author: Oluwafemi Adeagbo
Author: Janet Seeley
Author: Dumsani Gumede
Author: Sibongiseni Xulu
Author: Nondumiso Dlamini
Author: Manono Luthuli
Author: Jaco Dreyer
Author: Carina Herbst
Author: Frances Cowan
Author: Natsayi Chimbindi
Author: Karin Hatzold
Author: Nonhlanhla Okesola
Author: Cheryl Johnson
Author: Guy Harling
Author: Hasina Subedar
Author: Lorraine Sherr
Author: Nuala Mcgrath ORCID iD
Author: Elizabeth L. Corbett
Author: Maryam Shahmanesh

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