Determinants of assisted partner notification services for HIV testing among adults on HIV care in Seme and Kisumu West Sub Counties - Kenya

Abstract

Globally, assisted partner notification services (aPNS) has been found to be an efficient and cost-effective strategy towards human immunodeficiency virus (HIV) case finding and promotion of safer behaviors through HIV testing services (HTS). In sub–Saharan Africa, evidence showed that aPNS was acceptable, safe and provided preliminary evidence that it can be productively implemented to address major HIV case finding gaps. Therefore, there is need to investigate the determinants of aPNS. According to a study in Kenya, HIV case finding progress was made with 67% of infected individuals knowing their status due to aPNS. Since the current HTS approaches are not sufficient to get to 95% HIV case finding target by the year 2030, several studies have demonstrated that aPNS is an effective strategy in increasing HIV testing and linkage. However, there is need to understand the factors associated with the strategy. Increase of linkage to treatment among new identified HIV positive individuals due to aPNS has led to a decrease in HIV transmission. However, there is limited evidence on factors associated with uptake of aPNS. Consequently, the main objective of this study was to establish determinants of assisted partner notification services for HIV testing among adults on HIV care in Seme and Kisumu West Sub counties. The study was descriptive cross sectional by design. The study population was 9,942 HIV infected individuals accessing HIV care and treatment services in the study area, from which a sample size of 423 was drawn. The study sites were selected through stratified sampling method; 2 high volume facilities in Seme Sub County and 1 high volume facility in Kisumu West Sub County. Probability proportionate to size was used in respect to the population size among clients on HIV care and treatment services in the selected facilities. This enabled determination of the number of participants to be interviewed for each of the selected facilities. Within study facilities, simple random sampling was used to select study participants. Data was collected using questionnaires and analyzed for both descriptive and inferential statistics using STATA version 14.2. Findings indicated that, majority of the respondents (70%) had participated in aPNS prior to the study. Further, regarding referral methods, most respondents (40.4%) preferred provider referral followed by client referral (26.0%) with contract referral being the least preferred (20.8%). However, client referral method was the most preferred among those who had participated in aPNS (75.5%) while dual referral method was the preferred among those who had not benefited from aPNS (37.1%). The major barriers to enlisting partners for aPNS included stigma (30%), fear of separation (27.9%) and fear of taking blame (18.9%). Additionally, aPNS beneficiaries were 48% less likely to mention embarrassment and shame as one of the barriers of aPNS compared to aPNS non-beneficiaries (aOR=0.52; 95% CI, 0.31-0.87, p=0.013*). Moreover, those who had benefited from aPNS were 43% less likely to mention stigma as one of the barriers to aPNS compared to those who had not benefited from aPNS (aOR=0.57; 95% CI, 0.35-0.95, p=0.030*). Similarly, unfriendly services were the most common barrier among the non-beneficiaries. Those who participated in aPNS were 94% less likely to mention unfriendly services as one of the barriers (aOR=0.06; 95% CI, 0.02-0.18, p=<0.001*). However, unwillingness and inability to notify partner was the common barrier of aPNS among the beneficiaries. Beneficiaries were 2.3 times more likely to indicate unwillingness and inability to notify partner as one the barriers to aPNS (aOR=2.26; 95% CI, 1.04-4.88, p=0.039*). The association between aPNS and benefits of aPNS among the respondents was determined statistically significant (p=0.021). Notably, findings indicated that the only social demographic characteristic that had significance with aPNS uptake was residence of respondents (p=0.014*). The study recommended; implementation of both provider and client referral methods of notifying partners, aPNS implementation targeting urban settings and the younger generation and demand creation through health talks to increase awareness on the importance of aPNS.