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Implementation Science at UW

Keywords: Hanley Kingston

✪ Factors influencing community demand for assisted partner services for HIV in western Kenya: a multilevel qualitative analysis

Authors:

Mercy Owuor, Beatrice Wamuti, David A Katz, Wenjia Liu, Harison Lagat, Edward Kariithi, Brienna Naughton, Hanley Kingston, Mary Mugambi, Rose Bosire, Sarah Masyuko, Carey Farquhar, and Bryan J Weiner

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: March 2025

Read the full text in the open access journal BMJ Open

Abstract:

Objectives

This study explores factors affecting community-level demand for assisted partner services (APS) and HIV testing services (HTS) in western Kenya.

Design

This is a multilevel qualitative analysis conducted as part of the APS Scale-up Study, a hybrid type 2 implementation-effectiveness study of APS integrated within routine HTS. For this analysis, in-depth phone interviews assessed demand for APS and factors influencing decisions to participate in APS.

Setting

Participants were recruited from eight healthcare facilities and (for APS stakeholders) from affiliated healthcare institutions in western Kenya (Kisumu and Homabay). Interviews were conducted by phone in 2019 and 2020.

Participants

67 participants were interviewed: 14 APS providers, 16 female index clients, 17 male sexual partners and 20 community members. Participants were recruited using criteria-based purposive sampling to represent different types of facilities and to include indexes who named different numbers of partners and stakeholders representing all Kenyan healthcare system levels.

Results

Collectively, participants perceived that demand and uptake of APS could be impacted by multiple stigmas related to HIV, sexual behaviours and identities; long clinical wait times; certain gender norms and expectations; and fear of relationship dissolution, loss of financial support and intimate partner violence. However, different stakeholder groups generally focused on different factors; women focused more on gender dynamics and family roles; male sexual partners on stigma and structural barriers; HTS providers focused on HIV testing accessibility; and community-level stakeholders focused on low community awareness of APS.

Conclusions

Stigma reduction, awareness about APS, creation of male entry points at the facility level and provision of social support mechanisms have the potential to increase demand for APS.

Data availability statement

Data are available upon reasonable request. The datasets generated and/or analysed during the current study are not publicly available because some interview transcripts may contain sensitive individual information; however, they can be made available from the corresponding author on reasonable request.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Providing HIV-assisted partner services to partners of partners in western Kenya: an implementation science study

Authors:

Monisha Sharma, Barbara Wanjiku Mambo, Hanley Kingston, George Otieno, Sarah Masyuko, Harison Lagat, David A. Katz, Beatrice Wamuti, Paul Macharia, Rose Bosire , Mary Mugambi, Edward Kariithi, and Carey Farquhar

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: July 2024

Read the full text in the open access Journal of the International AIDS Society

Abstract:

Introduction

Assisted partner services (APS), or exposure notification and HIV testing for sexual partners of persons diagnosed HIV positive (index clients), is recommended by the World Health Organization. Most APS literature focuses on outcomes among index clients and their partners. There is little data on the benefits of providing APS to partners of partners diagnosed with HIV.

Methods

We utilized data from a large-scale APS implementation project across 31 facilities in western Kenya from 2018 to 2022. Females testing HIV positive at facilities were offered APS; those who consented provided contact information for all male sexual partners in the last 3 years. Male partners were notified of their potential HIV exposure and offered HIV testing services (HTS). Males newly testing positive were also offered APS and asked to provide contact information for their female partners in the last 3 years. Female partners of male partners (FPPs) were provided exposure notification and HTS. All participants with HIV were followed up at 12 months post-enrolment to assess linkage-to antiretroviral treatment (ART) and viral suppression. We compared HIV positivity, demographics and linkage outcomes among female index clients and FPPs.

Results

Overall, 5708 FPPs were elicited from male partners, of whom 4951 received HTS through APS (87% coverage); 291 FPPs newly tested HIV positive (6% yield), an additional 1743 (35.2%) reported a prior HIV diagnosis, of whom 99% were on ART at baseline. At 12 months follow-up, most FPPs were taking ART (92%) with very few adverse events: <1% reported intimate partner violence or reported relationship dissolution. FPPs were more likely than female index clients to report HIV risk behaviours including no condom use at last sex (45% vs. 30%) and multiple partners (38% vs. 19%).

Conclusions

Providing HIV testing via APS to FPP is a safe and effective strategy to identify newly diagnosed females and achieve high linkage and retention to ART and can be an efficient means of identifying HIV cases in the era of declining HIV incidence. The high proportion of FPPs reporting HIV risk behaviours suggests APS may help interrupt community HIV transmission via increased knowledge of HIV status and linkage to treatment.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**