Journal Article

Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study

Goggin, Kathy, Odeny, Beryne, Finocchario-Kessler, Sarah, Wexler, Catherine, Maloba, May, Mabachi, Natabhona, Gautney, Brad, Brown, Melinda

2019

Overview

At-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya. We conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources. Most providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before-possibly-learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier. While overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acceptance tests / Adult / Age / Analysis / Antiretroviral drugs / Antiretroviral therapy / Anxiety / Attitude / Babies / Biology and Life Sciences / Birth / Bonds (Securities) / Decision Making / Deoxyribonucleic acid / DNA / Evidence-based medicine / Evidence-based nursing / Evidence-based practice / Exposure / Fathers / Female / Gynecology / Health facilities / Health Personnel - psychology / HIV / HIV Infections - diagnosis / HIV tests / Human immunodeficiency virus / Humans / Infant Care / Infant, Newborn / Infants / Interviews as Topic / Kenya / Laboratories / Logistics / Male / Medical diagnosis / Medical tests / Medicine / Medicine and health sciences / Newborn infants / Obstetrics / Parenting / Parents / Parents - psychology / Parturition / Patients / People and Places / Point of care testing / Point-of-Care Systems / Postpartum / Pregnancy / Qualitative Research / Retirement benefits / Risk perception / Shortages / Social Sciences / Technological change / Workforce planning