TY - JOUR
T1 - Brief Report: "Give Me Some Time": Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda
T2 - Facilitators of and barriers to uptake of home-based HIV testing during household contact investigation for tuberculosis in Kampala, Uganda
AU - Armstrong-Hough, Mari
AU - Ggita, Joseph
AU - Ayakaka, Irene
AU - Dowdy, David
AU - Cattamanchi, Adithya
AU - Haberer, Jessica E.
AU - Katamba, Achilles
AU - Davis, J. Lucian
N1 - Funding Information:
Funding was provided by the U.S. National Institute of Allergy and Infectious Diseases grant NIH R01AI104824 (J.L.D.), and by an Innovative Grants Program Award from the Nina Ireland Program in Lung Health (https:// pulmonary.ucsf.edu/ireland/) at the University of California San Francisco (J.L.D.).
PY - 2018
Y1 - 2018
N2 - Background: Integrating home-based HIV counseling and testing (HCT) with tuberculosis (TB) evaluation could improve the uptake of HIV testing among household contacts of patients with active TB. We sought to identify the facilitators of and barriers to HCT during household contact investigation for TB in Kampala, Uganda. Methods: We nested semi-structured interviews with 28 household contacts who were offered home-based HCT in a householdrandomized trial of home-based strategies for TB contact investigation. Respondents reflected on their experiences of the home visit, the social context of the household, and their decision to accept or decline HIV testing. We used content analysis to identify and evaluate facilitators of and barriers to testing, then categorized the emergent themes using the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Results: Facilitators included a preexisting desire to confirm HIV status or to show support for the index TB patient; a perception that home-based services are convenient; and positive perceptions of lay health workers. Key barriers included fear of results and feeling psychologically unprepared to receive results. The social influence of other household members operated as both a facilitator and a barrier. Conclusions: Preexisting motivation, psychological readiness to test, and the social context of the household are major contributors to the decision to test for HIV at home. Uptake might be improved by providing normalizing information about HCT before the visit, by offering a second HCT opportunity, by offering self-tests with follow-up counseling, or by introducing HCT using "opt-out" language.
AB - Background: Integrating home-based HIV counseling and testing (HCT) with tuberculosis (TB) evaluation could improve the uptake of HIV testing among household contacts of patients with active TB. We sought to identify the facilitators of and barriers to HCT during household contact investigation for TB in Kampala, Uganda. Methods: We nested semi-structured interviews with 28 household contacts who were offered home-based HCT in a householdrandomized trial of home-based strategies for TB contact investigation. Respondents reflected on their experiences of the home visit, the social context of the household, and their decision to accept or decline HIV testing. We used content analysis to identify and evaluate facilitators of and barriers to testing, then categorized the emergent themes using the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Results: Facilitators included a preexisting desire to confirm HIV status or to show support for the index TB patient; a perception that home-based services are convenient; and positive perceptions of lay health workers. Key barriers included fear of results and feeling psychologically unprepared to receive results. The social influence of other household members operated as both a facilitator and a barrier. Conclusions: Preexisting motivation, psychological readiness to test, and the social context of the household are major contributors to the decision to test for HIV at home. Uptake might be improved by providing normalizing information about HCT before the visit, by offering a second HCT opportunity, by offering self-tests with follow-up counseling, or by introducing HCT using "opt-out" language.
KW - Home-based HIV counseling and testing
KW - Household contact investigation
KW - Implementation science
KW - Integrated HIV/TB evaluation
KW - Lay health workers
KW - Tuberculosis
KW - Humans
KW - Middle Aged
KW - Male
KW - Counseling/methods
KW - Home Care Services/organization & administration
KW - HIV Infections/diagnosis
KW - Randomized Controlled Trials as Topic
KW - Tuberculosis/diagnosis
KW - Young Adult
KW - Family Characteristics
KW - Patient Acceptance of Health Care
KW - Adolescent
KW - Adult
KW - Female
KW - Interviews as Topic
KW - Uganda
KW - Mass Screening/methods
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UR - http://www.scopus.com/inward/citedby.url?scp=85051638366&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000001617
DO - 10.1097/QAI.0000000000001617
M3 - Article
C2 - 29300218
AN - SCOPUS:85051638366
SN - 1525-4135
VL - 77
SP - 400
EP - 404
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 4
ER -