Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis

ObjectivePeer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised...

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Published in:	BMJ open Vol. 12; no. 2; p. e048780
Main Authors:	Adeagbo, Oluwafemi Atanda, Seeley, Janet, Gumede, Dumsani, Xulu, Sibongiseni, Dlamini, Nondumiso, Luthuli, Manono, Dreyer, Jaco, Herbst, Carina, Cowan, F, Chimbindi, Natsayi, Hatzold, Karin, Okesola, Nonhlanhla, Johnson, Cheryl, Harling, Guy, Subedar, Hasina, Sherr, Lorraine, McGrath, Nuala, Corbett, Liz, Shahmanesh, Maryam
Format:	Journal Article
Language:	English
Published:	England British Medical Journal Publishing Group 14.02.2022 BMJ Publishing Group LTD BMJ Publishing Group
Series:	Original research
Subjects:	Adolescent Adult Antiretroviral drugs Clinics Community Discount coupons Disease prevention Female Global Health health & safety Health promotion HIV HIV & AIDS HIV Infections - diagnosis HIV Infections - prevention & control HIV Testing Human immunodeficiency virus Humans Male Medical tests Peer tutoring Privacy Public health Qualitative research Seeds Self-Testing Sexual Health Social networks South Africa Women Young Adult Young adults South Africa United States > US HIV & AIDS public health health & safety
ISSN:	2044-6055, 2044-6055
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Abstract	ObjectivePeer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal.MethodsBetween March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18–29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach.ResultsOverall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake.ConclusionBoth professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.
AbstractList	Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal.OBJECTIVEPeer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal.Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18-29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach.METHODSBetween March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18-29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach.Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake.RESULTSOverall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake.Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.CONCLUSIONBoth professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP. Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal. Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): where peer-age friends distributed packs within their social network for a small incentive, or where peer navigators distributed HIVST packs directly. S peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18-29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach. Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake. Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP. ObjectivePeer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal.MethodsBetween March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): incentivised-peer-networks where peer-age friends distributed packs within their social network for a small incentive, or direct distribution where peer navigators distributed HIVST packs directly. Standard-of-care peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18–29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach.ResultsOverall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake.ConclusionBoth professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.
Author	Subedar, Hasina Adeagbo, Oluwafemi Atanda Chimbindi, Natsayi Shahmanesh, Maryam Seeley, Janet Cowan, F Corbett, Liz Hatzold, Karin Okesola, Nonhlanhla Harling, Guy Luthuli, Manono Dreyer, Jaco Dlamini, Nondumiso McGrath, Nuala Johnson, Cheryl Herbst, Carina Gumede, Dumsani Xulu, Sibongiseni Sherr, Lorraine
AuthorAffiliation	9 Department of HIV/AIDS , World Health Organization , Geneva , Switzerland 13 University College London Faculty of Population Health Sciences , London , UK 4 MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda 8 Population Services International , Harare , Zimbabwe 14 Faculty of Social, Human and Mathematical Sciences , University of Southampton , Southampton , UK 7 CeSHHAR Zimbabwe , Harare , Zimbabwe 11 Department of Epidemiology , Harvard University T H Chan School of Public Health , Boston , Massachusetts , USA 6 International Public Health , Liverpool School of Tropical Medicine , Liverpool , UK 2 Department of Sociology , University of Johannesburg , Auckland Park , South Africa 12 National Department of Health , Pretoria , South Africa 15 Infectious and Tropical Diseases , LSHTM , London , UK 10 Institute for Global Health , University College London , London , UK 3 Social Science & Research Ethics Unit , Africa Health Research Institute , Durban , South Africa 1 Department of Health P
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/35165105$$D View this record in MEDLINE/PubMed
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Keywords	HIV & AIDS public health health & safety
Language	English
License	This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
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antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TASP trial in rural South Africa publication-title: AIDS Care doi: 10.1080/09540121.2016.1164808 – ident: 2022021419103729000_12.2.e048780.15 doi: 10.1186/1471-2458-13-735 – volume: 22 Suppl 4 year: 2019 ident: 2022021419103729000_12.2.e048780.13 article-title: Understanding user perspectives of and preferences for oral PreP for HIV prevention in the context of intervention scale-up: a synthesis of evidence from sub-Saharan Africa publication-title: J Int AIDS Soc – ident: 2022021419103729000_12.2.e048780.30 doi: 10.1136/bmjgh-2018-000955 – volume: 21 start-page: 100327 year: 2020 ident: 2022021419103729000_12.2.e048780.19 article-title: Hiv self-testing among young women in rural South Africa: a randomized controlled trial comparing clinic-based HIV testing to the choice of either clinic testing or HIV self-testing with 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year: 2018 ident: 2022021419103729000_12.2.e048780.11 article-title: Acceptability of HIV self-testing in sub-Saharan Africa: Scoping study publication-title: AIDS Behav doi: 10.1007/s10461-017-1848-9 – volume: 15 year: 2020 ident: 2022021419103729000_12.2.e048780.28 article-title: Results from a cluster-randomized trial to evaluate a microfinance and peer health leadership intervention to prevent HIV and intimate partner violence among social networks of Tanzanian men publication-title: PLoS One doi: 10.1371/journal.pone.0230371 – ident: 2022021419103729000_12.2.e048780.21 doi: 10.1371/journal.pmed.1001102 – volume: 29 start-page: 617 year: 2015 ident: 2022021419103729000_12.2.e048780.43 article-title: "Just Because It's Out There, People Aren't Going to Use It." 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SubjectTerms	Adolescent Adult Antiretroviral drugs Clinics Community Discount coupons Disease prevention Female Global Health health & safety Health promotion HIV HIV & AIDS HIV Infections - diagnosis HIV Infections - prevention & control HIV Testing Human immunodeficiency virus Humans Male Medical tests Peer tutoring Privacy Public health Qualitative research Seeds Self-Testing Sexual Health Social networks South Africa Women Young Adult Young adults
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Title	Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis
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