Pregnant women and male partner perspectives of secondary distribution of HIV self-testing kits in Uganda: A qualitative study

Abstract

Background: HIV self-testing (HIVST) is a promising strategy to increase awareness of HIV status among sub-Saharan African (SSA) men. Understanding user perspectives on HIVST secondary distribution from pregnant women attending antenatal care (ANC) to their male partners is crucial to optimizing delivery strategies.

Methods: We sampled pregnant women attending ANC without their partners and purposively oversampled pregnant women living with HIV (PWHIV) to understand their unique views. We recruited male partners after obtaining contact information from women. We conducted 14 focus group discussions and 10 in-depth interviews with men and pregnant women. We assessed acceptability of HIVST secondary distribution, barriers, facilitators, and interventions to increase HIVST uptake.

Results: Participants felt that HIVST secondary distribution was acceptable, particularly for women in stable relationships. However, many expressed concerns about accusations of mistrust, relationship dissolution, fear of discovering serodifference, and lack of counseling associated with HIVST. PWHIV reported hesitation about secondary distribution, citing fears of unintended HIV status disclosure and abandonment resulting in financial hardship for themselves and their infant. Some participants preferred that providers contact men directly to offer HIVST kits instead of distribution via women. Participants reported that community sensitization, availability of phone-based counseling, male clinic staff, extended clinic hours, and financial incentives could increase men's HIVST use and linkage to care.

Conclusion: Participants expressed high interest in using HIVST, but secondary distribution was not universally preferred. We identified potential strategies to increase HIVST acceptability, particularly among PWHIV and those in unstable partnerships which can inform strategies to optimize HIVST distribution.

Fig 1

a. Standard cascade of HIVST secondary distribution. b. Re-envisioned cascade of HIVST distribution*. *PSG: peer support groups.

Fig 2. Socio-ecological model with barriers and facilitators.

Fig 2 summarizes the key themes discussed by participants, based on a socio-ecological model. Within each ring of the framework, common barriers for uptake of secondary distribution of HIVST are presented. Outside of the rings, common facilitators that could support or motivate uptake are presented; arrows point to barriers that the facilitators might be relevant for addressing.