Uptake of assisted partner notification services in high volume HIV care and treatment public health facilities in Tororo District, Uganda
MetadataShow full item record
Introduction: HIV testing service (HTS) is an important entry point for HIV prevention and treatment programs. Globally, of the 36 million people estimated to have HIV in 2015, 40% remained undiagnosed. About half of the people in HIV care have HIV+ partners, which makes Assisted Partner Notification (APN) one of the most efficient HIV testing approaches in terms of identifying new infections and linkage to HIV care. This study assessed APN uptake, associated factors, barriers to- and facilitators of its uptake. Objective: To determine uptake of APN services and associated factors among HIV positive patients enrolled in HIV care in Tororo district and the barriers to- and facilitators of uptake of APN services. Methodology: The study was conducted at four public health facilities in Tororo district, among HIV positive patients aged 18 and above, who were enrolled in HIV care. Quantitative data were collected from 343 participants that were interviewed using a semi- structured questionnaire and data analyzed using STATA version 14.0. In this study, the respondents who had the primary outcome of interest (APN uptake) were those HIV+ clients who used provider assistance to have their partners test for HIV. Qualitative data were obtained using 8 in-depth interviews and analyzed manually using the thematic approach. Univariable, bivariable and multivariable analyses were used to determine APN uptake and associated factors. Prevalence ratios and their p-values (significance was 0.2 at bivariate and 0.05 at multi-variate) were used as a measure of association. Approval was obtained from Makerere University School of Public Health (MakSPH) Higher Degrees Research and Ethics Committee (HDREC). Permission to conduct the study was granted from Tororo District Health Office (DHO). Results: Out of the 457 participants screened, we identified 387 eligible and 70 ineligible participants. 343 of the 387 participants (88.6%) consented and interviews were completed. More than half of the sample were female [56% (192/343)]. The mean age in completed years was 41 (SD-10). Of the 343 participants, over half [62.97% (216/343)] notified through provider assistance and had their partners take an HIV test. Among those who notified their partners, majority [65.7% (142/216)] reportedly used the passive notification approach. APN uptake had a significant association with alcohol use (P-0.009), condom use frequency (Sometimes [p-0.01], always [p-0.04], mode for HIV testing as community outreaches/ home based care (p-0.037). With more respondents reporting alcohol use, condom use, and community outreaches being more likely to use APN. Findings from the qualitative data showed good health worker attitude, home-based care, partner/ family support, provision of maternity services and good counselling as some of the factors that facilitated APN uptake while barriers to uptake included fear of abandonment and fear of loss of support. Conclusions: APN with direct assistance by the health worker was high in Tororo. Alcohol, condom, and community/home-based care users reported a high likelihood of using APN. Efforts aimed at strengthening APN services in Tororo district should address barriers to APN uptake by enhancing direct health worker engagement and targeting clients who presented with fears of abandonment and loss of support. Successful implementation of APN will help Tororo district and Uganda at large achieve zero new transmissions by the year 2030.