Challenges and Facilitators for HIV Testing Services and HIV Self-Testing Programming During Emergency Care in Kenya: A Qualitative Study of Patients

Abstract Background: Young people in Sub-Saharan Africa, especially young males, have been insufficiently engaged in HIV Testing Services (HTS). In Kenya, these persons are often treated in emergency departments (EDs) for injuries, a healthcare interaction that could be leveraged for HTS including HIV self-testing (HIVST). There is however, limited data from patients on ED-HTS which impedes programmatic advancement. Methods: A qualitative study was completed to understand challenges and facilitators for ED-HTS and HIVST delivery in Kenya (12/2021-03/2022). Data were collected via 28 in-depth patient interviews (14 males, 14 females) who had been treated for injury in the Kenyatta National Hospital (KNH) ED. Transcripts were coded, summarized, and analyzed with Dedoose™ software with both inductive and deductive codes to captured a priori and emergent themes. Data were mapped to the Capability-Opportunity-Motivation Behavioral (COM-B) model for health behavior change to identify interventions which could be used to enhanced ED-HIV services delivery. Results: Themes for challenges for ED-HTS included lack of testing, stigma, incompatibility with patient condition and lack of perceived confidentiality. Patients identified a range of facilitators for ED-HTS such as health maintenance, convenience, relevance to ED setting and trust in healthcare providers. Challenges to ED-HIVST programming included perceived testing inaccuracy, psychological impact and difficulties with follow-up. Themes on facilitators included greater privacy, supportive autonomy, time efficiency, increased accessibility and ease of testing. In mapping the data to the COM-B model, main identified themes for capability were adequate resources access and promotion of patient perceptions on testing importance. Opportunity themes identified appropriate timing for ED-HTS engagement and autonomy with HIVST use. Data themes for motivation included correct understanding of testing results, supportive patient-provider interactions, and increased agency in testing choices with varying options. These data correlated to intervention functions of education, environmental restructuring, enablement, training, modeling, incentivization anpersuasion which could be used to develop appropriate programs to promote ED-HTS delivery. Conclusion: ED patients view HTS and including HIVST as favorable. Although challenges exist, multiple pragmatic interventions can be leveraged in ED-based HIV services to enhance program development and impacts to deliver testing too difficult to reach persons already in contact with health systems.