背景:艾滋病毒接触者追踪中的自愿协助伴侣通知(VAPN)是一项全球推荐的策略,旨在识别已接触艾滋病毒的人,并将其与艾滋病毒检测和随访联系起来。然而,关于撒哈拉以南非洲(SSA)环境中利益相关者如何体验VAPN的了解很少。我们进行了多层次和多国家的定性分析,评估了利益相关者围绕VAPN实施的观点,以告知未来VAPN政策的发展。
方法:我们对全球的VAPN利益相关者进行了深入访谈(IDI)(n=5),国家(n=6),和社区水平(n=4)在总共七个SSA国家。符合条件的参与者年龄≥18岁,有发展经验,实施,或监督SSA中的VAPN策略。我们试图了解利益相关者对政策制定的看法,实施,和感知的结果(障碍和促进者)。采访是录音,转录,并使用归纳和演绎相结合的方法进行主题分析。
结果:在2019年12月至2020年10月之间,我们进行了15次IDI。虽然与会者一致认为VAPN导致了新诊断为艾滋病毒的人的高产量;他们注意到全球范围内围绕VAPN实施的许多障碍,国家,和社区层面,其中大多数是在社区一级确定的。全球和国家一级的障碍包括设定高目标,矛盾的法律,有限的独立研究剥夺了执行伙伴的经验。在社区层面确定的障碍包括客户层面的挑战(例如,获得医疗设施和对不良事件的恐惧);医护人员挑战(例如,高工作量);有限的数据基础设施;以及阻碍妇女参与艾滋病毒检测和VAPN服务的文化/性别规范。为了应对这些障碍,参与者共享实施促进者,以维持VAPN服务的道德实施(例如,接触追踪方法)并提高其产量(例如,与VAPN服务集成的艾滋病毒自检)。
结论:总体而言,利益相关者认为VAPN实施遇到了所有实施级别(全球到社区)的障碍。未来的VAPN政策应围绕SSA利益相关者确定的障碍和促进者进行设计,以最大程度地实施(道德)HIVVAPN服务,并增加其在撒哈拉以南非洲环境中的影响。
BACKGROUND: Voluntary assisted partner notification (VAPN) in HIV contact tracing is a globally recommended strategy to identify persons who have been exposed to HIV and link them to HIV testing and follow-up. However, there is little understanding about how VAPN is experienced by stakeholders in sub-Saharan African (SSA) contexts. We conducted a multi-level and multi-national qualitative analysis evaluating stakeholder perspectives surrounding VAPN implementation to inform the development of future VAPN policies.
METHODS: We conducted in-depth interviews (IDIs) with VAPN stakeholders at global (n = 5), national (n = 6), and community level (n = 4) across a total of seven SSA countries. Eligible participants were ≥ 18 years old and had experience developing, implementing, or overseeing VAPN policies in SSA. We sought to understand stakeholder\'s perspectives on policy development, implementation, and perceived outcomes (barriers and facilitators). Interviews were audio recorded, transcribed, and analyzed thematically using a combination of inductive and deductive approaches.
RESULTS: Between December 2019 and October 2020 we conducted 15 IDIs. While participants agreed that VAPN resulted in a high yield of people newly diagnosed with HIV; they noted numerous barriers surrounding VAPN implementation across global, national, and community levels, the majority of which were identified at community level. Barriers at global and national level included high target setting, contradictory laws, and limited independent research disenfranchising the experiences of implementing partners. The barriers identified at community level included client-level challenges (e.g., access to healthcare facilities and fear of adverse events); healthcare worker challenges (e.g., high workloads); limited data infrastructure; and cultural/gender norms that hindered women from engaging in HIV testing and VAPN services. In response to these barriers, participants shared implementation facilitators to sustain ethical implementation of VAPN services (e.g., contact tracing methods) and increase its yield (e.g., HIV self-testing integrated with VAPN services).
CONCLUSIONS: Overall, stakeholders perceived VAPN implementation to encounter barriers across all implementation levels (global to community). Future VAPN policies should be designed around the barriers and facilitators identified by SSA stakeholders to maximize the implementation of (ethical) HIV VAPN services and increase its impact in sub-Saharan African settings.