Healthcare providers’ perspective on barriers to optimal HIV index testing: an interview-based study

Abstract

Background: HIV testing services (HTS) and antiretroviral therapy have seen a substantial scale-up. Poorly targeted HTS have continued to miss people living with HIV who do not know their HIV status. This requires new and targeted approaches to reach undiagnosed people with HIV, such as HIV partner services. The aim of this study was to assess the barriers to optimal index testing for improved HIV testing yield in Lusaka, Zambia. Methods: One-to-one interviews were conducted with index testing providers to explore provider-related and client-related barriers to testing, and document other experiences arising during the process of HIV index testing. An interview guide was utilized for consistency of information collected. Results: Provider related challenges included inadequate elicitation skills among healthcare workers; low number of volunteers trained in index testing; inadequate index testing knowledge among staff; age and sex differences;  limited elicitation of index partners to only wife and husband (not eliciting all sexual partners); and limited transport for contact tracing. On the other hand, client-related challenges were mobile communities due to seasonal activities such as cross boarder trades, sex work and farming; some key populations and adolescent index clients do not have contact details for their casual relationships; provider’s age or gender difference for some clients; missing details on client locator forms or wrong details provided; stigma and discrimination; and limited space dedicated to conduct elicitation of index clients. Discussion: The challenges identified have future implications for index partner testing. These barriers were also gender and age specific. HIV testing services need to adapt to the social context of Zambia where HIV-related stigma and discrimination is still a challenge. As Zambia makes significant progress towards achieving HIV epidemic control, more effort is needed to address specific barriers to optimal HIV index testing.