Browsing by Author "Lisasi, Esther"

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    A systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa
    (2019-10-15) Njau, Bernard; Covin, Christopher; Lisasi, Esther; Damian, Damian; Mushi, Declare; Boulle, Andrew; Mathews, Catherine
    Abstract Background More than 40% of adults in Sub-Saharan Africa are unaware of their HIV status. HIV self-testing (HIVST) is a novel approach with a potential to increase uptake of HIV testing and linkage to care for people who test HIV positive. We explored HIV stakeholder’s perceptions about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing of adult users in Africa. Methods This systematic review of qualitative evidence included articles on qualitative studies published or made available between January 1998 to February 2018 on perspectives of key stakeholders, including HIV policymakers, HIV experts, health care providers, and adult men and women (18 years and above) about factors that enable or deter the uptake of HIV self-testing and experiences of self-testing among adult users. We searched CINAHL, MEDLINE in Pubmed, EMBASE, AJOL, PsycINFO, Social Science Citation Index (SSCI), and Web of Science for articles in English on HIVST with qualitative data from different African countries. Results In total, 258 papers were retrieved, and only nine (9) studies conducted in 5 African countries were eligible and included in this synthesis. Perceived facilitators of the uptake of HIVST were autonomy and self-empowerment, privacy, confidentiality, convenience, opportunity to test, including couples HIV testing, and ease of use. The perceived barriers included the cost of buying self-test kits, perceived unreliability of test results, low literacy, fear and anxiety of a positive test result, and potential psychological and social harms. HIV stakeholder’s concerns about HIVST included human right issues, lack of linkage to care, lack of face-to-face counseling, lack of regulatory and quality assurance systems, and quality of self-test kits. Actual HIVST users expressed preference of oral-fluid self-testing because of ease of use, and that it is less invasive and painless compared to finger-stick/whole blood-based HIV tests. Lack of clear instructions on how to use self-test kits, and existing different products of HIVST increases rates of user errors. Conclusions Overcoming factors that may deter HIV testing, and HIVST, in particular, is complex and challenging, but it has important implications for HIV stakeholders, HIVST users, and public health in general. Research is warranted to explore the actual practices related to HIVST among different populations in Africa.
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    Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania
    (2020-04-15) Njau, Bernard; Lisasi, Esther; Damian, Damian J; Mushi, Declare L; Boulle, Andrew; Mathews, Catherine
    Background Achieving the 95–95-95 global targets by 2030, innovative HIV testing models, such as HIV self-testing are needed for people, who are unaware of their HIV status. We aimed to explore key informants, mountain climbing porters, and female bar workers’ attitudes, perceived norms, and personal agency related to HIV self-testing. Methods This was a formative qualitative study to inform the design of an HIV self-testing intervention in Northern Tanzania. Informed by the Integrated Behaviour Model, we conducted four focus group discussions, and 18 in-depth interviews with purposively selected participants. Data were analyzed using the framework method. Results We recruited 55 participants. Most participants had positive attitudes towards HIVST, in that they anticipated positive consequences related to the introduction and uptake of HIVST. These included privacy and convenience, avoidance of long queues at health facilities, reduced counselor workload, and reduced indirect costs (given that transport to health facilities might not be required). Participants expressed the belief that significant people in their social environment, such as parents and peers, would approve their uptake of HIVST, and that they would accept HIVST. Additionally, features of HIVST that might facilitate its uptake were that it could be performed in private and would obviate visits to health facilities. Most participants were confident in their capacity to use HIVST kits, while a few were less confident about self-testing while alone. Strategies to maximize beliefs about personal agency and facilitate uptake included supplying the self-test kits in a way that was easy to access, and advocacy. Perceived potential constraints to the uptake of HIVST were the cost of buying the self-test kits, poverty, illiteracy, poor eyesight, fear of knowing one’s HIV status, lack of policy/ guidelines for HIVST, and the absence of strategies for linkage to HIV care, treatment, and support. Conclusions The findings suggest that HIVST may be feasible to implement in this study setting, with the majority of participants reporting positive attitudes, supportive perceived norms, and self-efficacy. Hence, future HIVST interventions should address the negative beliefs, and perceived barriers towards HIVST to increase HIV testing among the target population in Northern Tanzania.
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    Moving from pediatric to adolescent HIV care in Northern Tanzania: exploring transition services, perceptions and self-care during early adolescence
    (2025) Lisasi, Esther; Davies, Mary-Ann; Sikkema, Kathleen; Mmbaga, Blandina; Colvin, Christopher
    Given the increased survival of children with perinatally acquired HIV into adolescence due to increased coverage and access to antiretroviral therapy (ART) for children in Sub Saharan Africa (SSA), the pediatric-to-adolescent transition in HIV care is now of public health importance. There is, however, limited information available regarding pediatric-to-adolescent transition practices and how best to transition adolescents with perinatally acquired HIV from pediatric to adolescent HIV care clinics in Tanzania. This study therefore sought to understand how best to move adolescents with perinatally acquired HIV from pediatric to adolescent HIV care in Northern Tanzania during early adolescence. The specific objectives were: 1. To understand the current organization of pediatric-to-adolescent transitional care services and how this organization affects the perceptions and attitudes of transitioning adolescents during early adolescence. 2. To explore contextual factors other than service delivery that affect adolescents' and their caregivers' perceptions and attitudes towards transition before and after the move to adolescent clinics. 3. To understand the immediate effects of the transition from pediatric to adolescent care on medication adherence and clinic attendance management during early adolescence. Methods This was a mixed methods study that was carried out in three phases at two adolescent clinics in Northern Tanzania (KCMC zonal referral hospital and Mawenzi regional hospital). The first phase of the study was quantitative and used routinely collected clinical data of 345 adolescents aged ten to 18 years who were receiving HIV care in both hospitals. The second phase was a qualitative exploratory study that used in-depth interviews (IDIs) with eight adolescents who had already moved from pediatric to adolescent clinic. The third phase was a one-year longitudinal qualitative study that included repeated IDIs and focus group discussions with eight adolescents who were about to transition to adolescent clinics, eight of the adolescents' caregivers and ten service providers. Results Findings from the quantitative study show that there was no difference in socio-demographic and clinical characteristics of adolescents between the two hospitals and between transitioned and untransitioned adolescents. However, viral load suppression remained a challenge in many adolescents, regardless of whether they had transitioned to adolescent clinic or not. Despite three years of transitioning adolescents from pediatric to adolescent clinic, a huge backlog persisted, xi with 46% of eligible adolescents in the 13-18-year age group still receiving care in pediatric clinic at both hospitals indicating a service gap in the transition process. Exploration of the organization of pediatric-to-adolescent transition using qualitative methods revealed that disclosure of adolescents' HIV status was the essential factor to the pediatric-to adolescent transition. All adolescents had to be aware of their HIV status prior moving to the adolescent clinics. Medication adherence, virologic assessment, type of regimen, psychosocial maturity and mental health were also identified as critical aspects of readiness assessment prior to moving to adolescent clinic. High levels of caregiver engagement, interaction, communication, and support were required to guide the transition, particularly for caregivers living with HIV who have been receiving HIV care together with their adolescents since childhood. Overall, there was a well-established transition practice. However, the lack of written protocols/national guidelines and the limited availability of human resources were the limiting factors to the provision of evidence-informed transition practices. Hence, variations in pediatric-to-adolescent transition practices across healthcare facilities in Tanzania are likely to occur given the absence of national guidelines governing this process. Exploration of influential factors revealed that psychosocial adjustment following disclosure, perceived self-efficacy, perceived stigma as well as feelings of personal responsibility, privacy and confidentiality at the clinic were all individual level factors that affected acceptability of the adolescent clinic and adolescents' continuation with care after transition At caregiver level, caregiver readiness and especially caregivers living with HIV who are also required to transition to adult clinic, fear of stigma and critical events in the family influenced caregivers' decisions regarding the pediatric-to-adolescent transition. At all stages of the transition to adolescent clinic, peer influence and support were important factors. The organization of transition services also affected adolescents' decisions and care continuity, especially in health facility settings where moving to a different clinic could lead to HIV identification. Transition practices requiring adolescents to move to an adult clinic in the event of pregnancy or marriage before age 24 limited pediatric-to-adolescent transition success. Finally, broader structural factors such as the education system where adolescents in grade seven are required to attend classes on Saturdays and the religion where most adolescents attend religious (confirmation and madrassa) classes on Saturdays also influenced adolescents' and caregivers' perceptions towards this transition. Lastly, since many adolescents in Tanzania attend boarding schools, these impacted not only the pediatric-to-adolescent transition process but also continuity with HIV care due to a lack of HIV services in boarding schools and lack of privacy in keeping and taking of one's medicines. xii Immediate effects of the pediatric-to-adolescent transition on the level of responsibilities assumed by adolescents were mixed. In some adolescents, the pediatric-to-adolescent transition resulted in an increase in medication adherence and clinic attendance responsibilities, whereas in others, medication adherence and clinic attendance responsibilities decreased or were unaffected. Several factors contributed to these outcomes which include peer influence, peer support, sense of responsibility for one's health, the level of caregivers' engagement in these activities, adolescents' living conditions and fear of stigma. Adolescents appeared to often assume responsibilities for medication adherence and clinic attendance well before the transition period and adolescents of caregivers living with HIV assumed more responsibilities than other adolescents. However, there was no national transition guide to assist healthcare workers in providing systematic and evidence-based support to caregivers in transferring autonomy to adolescents for clinic attendance and medication adherence related tasks. As a result, it may be challenging to ensure smooth transition of responsibilities from caregivers to adolescents in a chronologically, developmentally, behaviorally, clinically, psychologically and culturally appropriate manner for the Tanzanian context. Conclusion In conclusion, the pediatric-to-adolescent transition of HIV care for adolescents living with perinatally acquired HIV is a bi-faceted (adolescent and caregivers), multi-stage (from disclosure to transition to adult clinic) and ongoing process that needs to attend to the medical, psychosocial, and developmental needs of adolescents at all stages as well as caregivers' needs. This pediatric to-adolescent transition provides a chance to strengthen adolescents' autonomy and connections to their peers and friends which is an important psychosocial aspect of HIV care and highly valued by adolescents. Therefore, with adequate planning, oversight, and adolescent and caregiver involvement in all transition stages, pediatric-to-adolescent transitional programs can increase adolescents' engagement in care, lead to timely identification of risk factors influencing this transition, and eventually foster self-care to transitioning adolescents.