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Organisation of testing services, structural barriers and facilitators of routine HIV self-testing during sexually transmitted infection consultations: a qualitative study of patients and providers in Abidjan, Côte d’Ivoire

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年2月27日

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  • Sokhna Boye,
  • Alexis Kouadio,
  • Amélé Florence Kouvahe,
  • Anthony Vautier,
  • Odette Ky-Zerbo,
  • Nicolas Rouveau,
  • Mathieu Maheu-Giroux,
  • Romain Silhol,
  • Arlette Simo Fotso,
  • Joseph Larmarange,
  • Dolorès Pourette,
  • Georges Amani Elvis,
  • Kéba Badiane,
  • Céline Bayac,
  • Anne Bekelynck,
  • Marie-Claude Boily,
  • Guillaume Breton,
  • Marc d’Elbée,
  • Alice Desclaux,
  • Annabel Desgrées du Loû,
  • Moussa Diop Papa,
  • Clémence Doumenc-Aïdara,
  • Eboi Ehui,
  • Medley Graham,
  • Kévin Jean,
  • Abdelaye Keita,
  • Arsène Kouassi Kra,
  • Graham Medley,
  • Raoul Moh,
  • Tidiane Ndour Cheikh,
  • Fern Terris-Prestholt,
  • Mohamed Traore Métogara,
  • Sanata Diallo,
  • Alioune Gueye Papa,
  • Olivier Geoffroy,
  • Odé Kanku Kabemba,
  • Armand Abokon,
  • Camille Anoma,
  • Annie Diokouri,
  • Blaise Kouame,
  • Venance Kouakou,
  • Odette Koffi,
  • Alain-Michel Kpolo,
  • Josiane Tety,
  • Yacouba Traore,
  • Jules Bagendabanga,
  • Djelika Berthé,
  • Daouda Diakite,
  • Mahamadou Diakité,
  • Youssouf Diallo,
  • Minta Daouda,
  • Septime Hessou,
  • Saidou Kanambaye,
  • Abdul Karim Kanoute,
  • Dembele Bintou Keita,
  • Dramane Koné,
  • Mariam Koné,
  • Almoustapha Maiga,
  • Telly Nouhoum,
  • Abdoulaye Sanogo,
  • Keita Aminata Saran,
  • Fadiala Sidibé,
  • Madani Tall,
  • Camara Adam Yattassaye,
  • Idrissa Bâ,
  • Amadou Niang Diallo Papa,
  • Fatou Fall,
  • Fatou NGom Guèye NDèye,
  • Sidy Mokhtar Ndiaye,
  • Alassane Moussa Niang,
  • Oumar Samba,
  • Safiatou Thiam,
  • Nguissali M. E. Turpin,
  • Seydou Bouaré,
  • Cheick Sidi Camara,
  • Ehua Agnes Eponon,
  • Marie-Anne Montaufray,
  • Rosine Mosso,
  • Pauline Dama Ndeye,
  • Sophie Sarrassat,
  • Souleymane Sow

摘要

Background

Consultations for sexually transmitted infection (STI) provide an opportunity to offer HIV testing to both patients and their partners. This study describes the organisation of HIV self-testing (HIVST) distribution during STI consultations in Abidjan (Côte d’Ivoire) and analyse the perceived barriers and facilitators associated with the use and redistribution of HIVST kits by STI patients.

Materials and methods

A qualitative study was conducted between March and August 2021 to investigate three services providing HIVST: an antenatal care clinic (ANC), a general health centre that also provided STI consultations, and a dedicated STI clinic. Data were collected through observations of medical consultations with STI patients (N = 98) and interviews with both health professionals involved in HIVST distribution (N = 18) and STI patients who received HIVST kits for their partners (N = 20).

Results

In the ANC clinic, HIV testing was routinely offered during the first prenatal visit. HIVST was commonly offered to women who had been diagnosed with an STI for their partner’s use (27/29 observations). In the general health centre, two parallel pathways coexisted: before the consultation, a risk assessment tool was used to offer HIV testing to eligible patients and, after the consultation, patients who had been diagnosed with an STI were referred to a care assistant for HIVST. Due to this HIV testing patient flow, few offers of HIV testing and HIVST were made in this setting (3/16). At the dedicated STI clinic, an HIVST video was played in the waiting room. According to the health professionals interviewed, this video helped reduce the time required to offer HIVST after the consultation. Task-shifting was implemented there: patients were referred to a nurse for HIV testing, and HIVST was commonly offered to STI patients for their partners’ use (28/53). When an HIVST was offered, it was generally accepted (54/58). Both health professionals and patients perceived HIVST positively despite experiencing a few difficulties with respect to offering HIVST to partners and structural barriers associated with the organisation of services.

Conclusion

The organisation of patient flow and task-shifting influenced HIV testing and offers of HIVST kits. Proposing HIVST is more systematic when HIV testing is routinely offered to all patients. Successful integration requires improving the organisation of services, including task-shifting.