A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa

BMC Public Health

Sonja Merten³  Adriane Martin-Hilber³  Virginia Bond¹  Oran Mckenzie⁴  Sara Gari³  Harriet Ntalasha²  Maurice Musheke³ 

[1]Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, U004B

[2]Department of Social Development Studies, University of Zambia, Lusaka, Zambia

[3]University of Basel, Faculty of Science, Petersplatz 1, Basel, CH-4003, Switzerland

[4]Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland

关键词: Sub-Saharan Africa;    Meta-ethnography;    Antiretroviral therapy;    HIV testing;    HIV;   

Others  :  1162459
DOI  :  10.1186/1471-2458-13-220

 received in 2012-09-11, accepted in 2013-03-06,  发布年份 2013

【 摘 要 】

Background

Despite Sub-Saharan Africa (SSA) being the epicenter of the HIV epidemic, uptake of HIV testing is not optimal. While qualitative studies have been undertaken to investigate factors influencing uptake of HIV testing, systematic reviews to provide a more comprehensive understanding are lacking.

Methods

Using Noblit and Hare’s meta-ethnography method, we synthesised published qualitative research to understand factors enabling and deterring uptake of HIV testing in SSA. We identified 5,686 citations out of which 56 were selected for full text review and synthesised 42 papers from 13 countries using Malpass’ notion of first-, second-, and third-order constructs.

Results

The predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. Other enabling factors are availability of treatment and social network influence and support. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality which undermines women’s decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing.

Conclusions

Improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs of seeking HIV testing could also contribute towards increasing uptake of HIV testing in SSA.

【 授权许可】

   
2013 Musheke et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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