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

Oluwafemi Atanda Adeagbo; Janet Seeley; Dumsani Gumede; Sibongiseni Xulu; Nondumiso Dlamini; Manono Luthuli; Jaco Dreyer; Carina Herbst; F Cowan; Natsayi Chimbindi; Karin Hatzold; Nonhlanhla Okesola; Cheryl Johnson; Guy Harling; Hasina Subedar; Lorraine Sherr; Nuala McGrath; Liz Corbett; Maryam Shahmanesh

doi:10.1136/bmjopen-2021-048780

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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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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

Oluwafemi Atanda Adeagbo, Janet Seeley, Dumsani Gumede, Sibongiseni Xulu, Nondumiso Dlamini, Manono Luthuli, Jaco Dreyer, Carina Herbst, F Cowan, Natsayi Chimbindi, …

BMJ open, Vol.12(2), pp.e048780-e048780

02/14/2022

DOI: 10.1136/bmjopen-2021-048780

PMCID: PMC8845207

PMID: 35165105

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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.

Global health

health & safety

HIV & AIDS

public health

Details

Title: Subtitle: 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
Creators: Oluwafemi Atanda Adeagbo - University of Johannesburg
Janet Seeley - Africa Health Research Institute
Dumsani Gumede - Africa Health Research Institute
Sibongiseni Xulu - Africa Health Research Institute
Nondumiso Dlamini - Africa Health Research Institute
Manono Luthuli - Africa Health Research Institute
Jaco Dreyer - Africa Health Research Institute
Carina Herbst - Africa Health Research Institute
F Cowan - Liverpool School of Tropical Medicine
Natsayi Chimbindi - Africa Health Research Institute
Karin Hatzold - Population Services International
Nonhlanhla Okesola - Africa Health Research Institute
Cheryl Johnson - World Health Organization
Guy Harling - Harvard University
Hasina Subedar - National Department of Health, Pretoria, South Africa.
Lorraine Sherr - University College London Faculty of Population Health Sciences, London, UK.
Nuala McGrath - University of Southampton
Liz Corbett - London School of Hygiene & Tropical Medicine
Maryam Shahmanesh - Africa Health Research Institute
Resource Type: Journal article
Publication Details: BMJ open, Vol.12(2), pp.e048780-e048780
DOI: 10.1136/bmjopen-2021-048780
PMID: 35165105
PMCID: PMC8845207
NLM abbreviation: BMJ Open
ISSN: 2044-6055
eISSN: 2044-6055
Publisher: British Medical Journal Publishing Group
Grant note: 5R01MH114560-03 / National Institute of Health (NIH) RP-2017-08-ST2-008 / NIHR Research Professorship Award 082384/Z/07/Z / Wellcome (http://dx.doi.org/10.13039/100010269) PO#10140-0-600 / UNITAID
Language: English
Date published: 02/14/2022
Academic Unit: Community and Behavioral Health
Record Identifier: 9984274664902771

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