HIV testing services and HIV self-testing programming within emergency care in Kenya: a qualitative study of healthcare personnel to inform enhanced service delivery approaches

• Published in: AIDS care 2025-01, Vol.37 (1), p.112-123
• Main Authors: Aluisio, Adam R., Bergam, Scarlett J., Kinuthia, John, Maina, John Wamutitu, Pirirei, Sankei, Bukusi, David, Waweru, Harriet, Bosire, Rose, Chen, Josephine, Ojuka, Daniel K., Katz, David A., Farquhar, Carey, Mello, Michael J., Guthrie, Kate M.
• Format: Article
• Language: English
• Subjects: Adult; Autonomy; Behavior; Challenges; Confidentiality; Coordination; Delivery of Health Care; emergency health services; Emergency medical care; Emergency Medical Services; Emergency Service, Hospital; Emergency services; Environmental aspects; Female; Focus Groups; Health care; Health Personnel; HIV; HIV Infections - diagnosis; HIV self-Testing; HIV Testing - methods; HIV testing services; Human immunodeficiency virus; Humans; Influence; Kenya; Male; Mapping; Mass Screening - methods; Medical personnel; Medical tests; Middle Aged; Motivation; Nurses; Psychosocial factors; Qualitative analysis; Qualitative Research; Resource utilization; SDG 10: Reduced inequalities; SDG 3: Good health and well-being; Self testing; Systems integration; Tests; Workers
• ISSN: 0954-0121; 1360-0451; 1360-0451
• DOI: 10.1080/09540121.2024.2414087

In Kenya, persons insufficiently engaged in HIV Testing Services (HTS) are often treated in emergency departments (ED). There are limited data from healthcare workers on ED-HTS. A qualitative study was completed to understand challenges and facilitators for ED-HTS and HIV self-testing (HIVST). Data were collected via six focus groups of healthcare workers. Data were inductively analyzed and mapped to the Capability-Opportunity-Motivation Behavioral Model. Focus groups were completed with 49 healthcare workers: 18 nurses, 15 HIV counselors, 10 physicians and 6 administrators. HTS challenges included staff burdens, resources access, deficiencies in systems integration and illness severity. HTS facilitators included education of healthcare workers and patients, services coordination, and specific follow-up processes. HIVST challenges included accuracy concerns, follow-up barriers and psychosocial risks. HIVST facilitators were patient autonomy and confidentiality, resource utilization and ability to reach higher-risk persons. Mapping to the Capability-Opportunity-Motivation Behavioral Model interventions within the domains of knowledge, decision processes, environmental aspects, social influences and professional identities could support enhanced ED-HTS with integrated HIVST delivery. This study provided insights into challenges and facilitators on ED-HTS and identifies pragmatic approaches to improve healthcare workers' behaviors and abilities to provide services to persons already in contact with healthcare.