Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

At-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya.

Methods

We conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources.

Results

Most providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before–possibly–learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier.

Discussion

While overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.

Related collections

Most cited references 25

Record: found
Abstract: not found
Article: not found

The connection between evidence-based medicine and shared decision making.

Tammy Hoffmann, Victor Montori, Chris Del Mar (2014)

0 comments Cited 148 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns

Sheri D Weiser, Michele Heisler, Karen Leiter … (2006)

Introduction There has been widespread concern about the slow uptake of voluntary counseling and testing (VCT) in many parts of sub-Saharan Africa [ 1, 2]. VCT is a cornerstone of cost-effective HIV prevention and linkage to expanding HIV treatment in low-resource settings [ 3, 4]. Some of the most significant barriers to HIV testing identified in sub-Saharan Africa include lack of access to VCT and to high quality clinical services, lack of access to antiretroviral (ARV) therapy, and HIV-related stigma [ 1, 5, 6]. With a seroprevalence of 37% of adults ages 15–49 [ 7, 8], Botswana established universal access to antiretroviral treatment (ART) beginning in 2002 for all patients with CD4 counts less than 200 or with an AIDS-defining illness [ 9– 11]. By January 2004, however, only 17,500 patients were enrolled in the Botswana National Treatment Program out of an estimated 110,000 eligible individuals [ 9]. Slow enrollment in HIV treatment was thought to be due in part to underutilization of HIV testing [ 9, 11, 12]; by mid-2003, only 70,000 tests in total had been performed in Botswana out of a population of 1.7 million [ 13]. HIV stigma was identified by government and press sources as one possible impediment to HIV testing and hence to the success of the new ART program, in that individuals may avoid testing and treatment facilities to avoid potential stigma and discrimination [ 8, 11, 13]. We previously reported that social stigma and fear of positive test results significantly delayed testing among a group of patients treated in the private sector in 2000 [ 14]. In an attempt to increase the uptake of HIV testing and ART, the Botswana government introduced the policy of routine HIV testing in early 2004, whereby nearly all patients would be tested as a routine part of medical visits unless they explicitly refused [ 13, 15]. While this approach to testing is provider-initiated, all patients should receive essential information about HIV testing and be informed of their right to refuse. In addition, there is typically greater emphasis on post-test compared with pre-test counseling [ 16]. Studies in resource-rich settings have shown that routine HIV testing can be cost-effective and life-saving, both by increasing the life expectancy of individuals with HIV and by reducing the annual HIV transmission rate [ 17– 21]. In June 2004, as part of a change in testing policy recommendations, UNAIDS and the World Health Organization recommended the routine offer of HIV testing by healthcare providers in a wide range of clinical encounters based in part on the Botswana experience [ 22, 23]. The goal of routine testing is to increase the proportion of individuals aware of their status, and thereby reduce “HIV exceptionalism,” lessen HIV-related stigma, and provide more people access to life-saving therapy [ 16, 24]. While provider-initiated approaches to testing are gaining popularity, there have been concerns that routine testing policies are potentially coercive, that counseling will no longer be practiced, that people may be dissuaded from visiting their doctors for fear of being tested, and that this policy may increase testing-related partner violence [ 15, 25– 27]. As routine testing is increasingly being recommended as an option in other countries [ 17, 18, 28– 30], it is important to improve our understanding of the consequences and specific human rights concerns associated with implementation of this policy in Botswana. We therefore assessed: 1) knowledge of and attitudes toward routine testing in Botswana with a focus on human rights concerns associated with this policy; 2) factors associated with whether respondents had heard of routine testing, and with positive attitudes toward this policy; and 3) the prevalence and correlates of HIV testing, barriers and facilitators to testing, and reported experiences with testing 11 months after the introduction of routine testing in Botswana. Methods In November and December 2004, we conducted a cross-sectional study using structured survey instruments among a probability sample of 1,268 adults selected from the five districts of Botswana with the highest number of HIV-infected individuals. These districts included Gaborone, Kweneng East, Francistown, Serowe/Palapye, and Tutume, and cover a population of 725,000 out of a total population of 1.7 million individuals in Botswana. We used a stratified two-stage probability sample design for the selection of the population-based sample with the assistance of the Central Statistics Office at the Ministry of Finance and Development Planning in Botswana. In the first stage of sampling, 89 enumeration areas were selected with probability proportional to measures of size, where measures of size are the number of households in the enumeration area as defined by the 2001 Population and Housing Census. At the second stage of sampling, households were systematically selected in each enumeration area by trained field researchers under the guidance of field supervisors. With a target sample of 1,200 households, and 15% over-sampling for an anticipated 85% response rate, 1,433 households were selected. Within each household, random number tables were used to select one adult member who met our inclusion criteria, and up to two repeat visits were made. Participants were excluded if they were older than 49 or younger than 18 years old, if they had cognitive disabilities, or if there was inadequate privacy to conduct the interviews. The 45- to 60-minute survey was conducted in either English or Setswana in a private setting, and written consent was obtained from all study participants. Our structured survey instrument and consent forms were pilot-tested among 20 individuals from Gaborone, and then translated into Setswana and back-translated into English. All study procedures were approved by the Human Subjects Committee at the University of California San Francisco (San Francisco, California, United States), as well as by the Botswana Ministry of Health Research and Development Committee. Measures Domains of inquiry for our 234-item survey ( Protocol S1) included demographics, HIV knowledge, experiences with HIV testing, barriers and facilitators to HIV testing, attitudes toward routine testing, HIV risk behaviors, HIV-related stigma, depression, beliefs about gender roles and gender discrimination, and measures of healthcare access and utilization. Based on an extensive literature review [ 2, 6, 31– 37] and discussions with key informants, we developed a conceptual model that guided the selection of variables for our multivariate model for correlates of testing, as shown in Figure 1. Relevant variables are explained below. Knowledge of and attitudes toward routine testing. Participants were asked whether they had heard of routine testing and were given a detailed explanation of this policy (see Table 1). Participants then indicated the extent to which they are in favor of routine testing and whether they think this policy affects HIV-related stigma, barriers to testing, violence against women related to testing, and uptake of ARVs. From questions assessing attitudes toward routine testing ( Table 1), we constructed an ordinal outcome of positive attitudes toward this policy. Participants were categorized as having zero to one, two, three, or four positive views toward routine testing. (See Tables 1 and 2 for specific items.) HIV testing. Participants were asked whether they had ever been tested for HIV (by either VCT or routine testing). If so, they were asked detailed questions about their experiences with pre-test and post-test counseling, confidentiality, facilitators to testing, and personal repercussions of testing. If not, they were asked a series of questions related to barriers to testing adapted from the CDC HIV Testing Instrument, version 9.00, and about their intention to be tested within the next six months. HIV status was not asked in order to maximize response rate and hence the generalizability of the population-based sample. HIV-related stigma. Respondents were asked seven questions representing potential stigmatizing attitudes adapted from the UNAIDS general population survey and the Department of Health Services AIDS module, which have been used successfully in previous studies in Botswana [ 38]. Anyone who reported a discriminatory attitude on any of four principal questions was registered as having stigmatizing attitudes per the UNAIDS scoring system. Since participants may not always openly endorse stigmatizing views toward people living with HIV and AIDS (PLWA) due to social desirability bias, as an additional measure of stigma, we also asked individuals to project the type of responses they would anticipate from others if they were to test positive for HIV and divulge their status to others. We converted this information to a nine-item index on “projected HIV stigma” with higher scores associated with a greater number of reported adverse social consequences associated with testing positive. This index had high internal reliability with a Cronbach alpha of 0.77. HIV knowledge. Participants were asked 15 questions about their knowledge of HIV transmission and prevention, based on questions modified from the UNAIDS General Population Survey and the Department of Health Services AIDS module. Using the UNAIDS knowledge indicator scoring system, individuals were scored as having HIV knowledge if they correctly identified the two most common modes of HIV prevention in Botswana. Depression. As depression is known to impede access to care and to worsen HIV outcomes in Western settings, we included depression in our analysis [ 39– 41]. Symptoms of depression were measured using the 15-item Hopkins Symptom Checklist for Depression [ 42] which has been validated previously in locations in Africa and elsewhere [ 43]. Analysis We used standard procedures for data entry and quality control. All data were analyzed with S TATA statistical software. Outcomes of interest included: a) having heard of routine testing; b) number of positive attitudes toward routine testing (categorized as an ordinal variable consisting of the following categories: zero to one, two, three, and four positive statements about routine testing); c) self-reported HIV testing (by either VCT or routine testing); d) having been tested under routine testing; and e) planning to test within the next six months (among people who had not tested). The following covariates were included in our analyses: 1) age (continuous); 2) sex; 3) income (≥population mean,

0 comments Cited 78 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Toward a transdisciplinary model of evidence-based practice.

Jenny Mullen, Ross C. Brownson, Evelyn Whitlock … (2009)

This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal "three circles" model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines. The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline. Common challenges across disciplines include (1) how "evidence" should be defined and comparatively weighted; (2) how and when the patient's and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the "expert"; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise. A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner's expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed.

0 comments Cited 69 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Catherine Wexler:

ORCID: http://orcid.org/0000-0003-1891-9165

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing

May Maloba: Role: Data curationRole: MethodologyRole: Project administrationRole: Writing – review & editing

Melinda Brown: Role: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – review & editing

Natabhona Mabachi: Role: Data curationRole: MethodologyRole: Writing – review & editing

Kathy Goggin: Role: ConceptualizationRole: MethodologyRole: Writing – review & editing

Brad Gautney: Role: ConceptualizationRole: MethodologyRole: Writing – review & editing

Beryne Odeny: Role: Data curationRole: Formal analysisRole: Writing – review & editing

Sarah Finocchario-Kessler: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing

Sphiwe Madiba: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 22 November 2019

Publication date Collection: 2019

Volume: 14

Issue: 11

Electronic Location Identifier: e0225642

Affiliations

[1 ] Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America

[2 ] Global Health Innovations, Nairobi, Kenya

[3 ] Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, United States of America

[4 ] School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America

[5 ] Global Health Innovations, Dallas, TX, United States of America

Sefako Makgatho Health Sciences University, SOUTH AFRICA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

‡ These authors also contributed equally to this work.

* E-mail: cwexler@ 123456kumc.edu

Author information

Catherine Wexler http://orcid.org/0000-0003-1891-9165

Article

Publisher ID: PONE-D-19-14621

DOI: 10.1371/journal.pone.0225642

PMC ID: 6874324

PubMed ID: 31756242

SO-VID: 565c2c24-1a61-4cc9-89c1-49875f8568f4

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 24 May 2019

Date accepted : 9 November 2019

Page count

Figures: 2, Tables: 2, Pages: 17

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100000071, National Institute of Child Health and Human Development;

Award ID: 3R01HD076673-04S2

Award Recipient : Sarah Finocchario-Kessler

Research reported in this publication was supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health under award number 3R01HD076673-04S2, awarded to Finocchario-Kessler at the University of Kansas Medical Center. A percent of each author’s effort was supported by this grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability We have consulted with the IRB at the University of Kansas Medical Center. Since the informed consent given to participants stated that participant data would be accessible only to study team members, the IRB is placing restriction on sharing even de-identified data. Data requests can be may be sent to our IRB at humansubjects@ 123456kumc.edu .

Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study

Read this article at

Abstract

Background

Methods

Results

Discussion

Related collections

PLOS Climate

Most cited references 25

The connection between evidence-based medicine and shared decision making.

Routine HIV Testing in Botswana: A Population-Based Study on Attitudes, Practices, and Human Rights Concerns

Toward a transdisciplinary model of evidence-based practice.

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 180

Cited by 10

Most referenced authors 378