Added: Kari Dierks - Date: 06.08.2021 05:53 - Views: 45627 - Clicks: 8023
Metrics details. To achieve the first target, no person should be left behind in their access to HIV testing services.
In Kenya, HIV prevention and testing services give less emphasis on older adults. This article describes HIV testing experiences of older adults living with HIV and how their age shaped their interaction and treatment received during HIV testing and diagnosis. We conducted in depth interviews IDIs with 25 participants and 4 focus group discussions FGDs with a total of 32 participants and audio recorded all the sessions.
We transcribed audio records and analyzed the data using thematic content analysis method. The testing and counseling sessions were described as short and hurried within the hospital settings, whereas the interactions with service providers in home-based testing were experienced as appropriate and supportive. Participants in this study expressed preference for healthcare providers who were older and of similar gender. Peer Review reports. This is expected to rise in the coming years due to the wide access of antiretroviral treatment ART where people infected with HIV at a younger age are growing older as well as new infections occurring among the older adults.
Though the Kenyan Government has adopted various testing strategies including voluntary counselling and testing VCTprovider-initiated testing and counselling PITCdiagnostic testing and counselling DTChome-based counselling and testing HBCTand recently self-testing, older adults still lag behind in accessing HIV testing services compared to other age groups.
There are several reasons for this: first, very little HIV prevention education is targeted at older people [ 5 ], second, health care providers may not test older people for HIV [ 6 ], and third, older people may lack awareness of the risk factors for getting HIV [ 7 ].
As a result, older adults are deprived of the benefits of early diagnosis of HIV infection including timely initiation of HIV treatment. The literature indicates that adults continue to be sexually active into their old age, including sexual practices often associated with younger people such as inconsistent condom use, sex with multiple sexual partners and casual sex [ 89101112 ]. Such sexual behaviors put older adults at risk of acquiring HIV from infected partners or transmitting HIV to an uninfected partner.
Despite these risk factors, adults aged 50 years and above are less likely to be tested for HIV than younger adults testing [ 7813 ]. As a consequence, older adults get diagnosed late into the HIV infection, likely after developing symptoms [ 14 ], and only when visiting the hospital for health complications. To address this gap in literature, we draw on qualitative interviews with older HIV-infected adults in western Kenya and analyze their experiences in HIV testing, including explorations on access of testing services and how they perceived their interactions with healthcare providers during testing.
The program provides comprehensive HIV care in Ministry of Health MOH facilities spread throughout western part of Kenya and is currently the largest program providing free HIV care and treatment in the country [ 16 ]. Participants aged 50 years and above at the time of HIV care enrollment were selected from one urban and one rural facility to allow for a comparison of these settings, with a note that prevalence of HIV in Kenya is higher in urban than in rural settings [ 17 ].
Both of the selected sites served a large of older persons when compared to other facilities. Qualitative research methods were used to generate detailed descriptions of experiences of the participants living with HIV.
In-depth interviews IDI and focus group discussions were employed in this study. The interviews were conducted in Kiswahili, the Kenyan national language, and lasted between 60 and 90 min each. We interviewed 25 participants; 16 9 males and 7 females participants from urban facility and 9 5 males and 4 females from rural facility. We also conducted four focus group discussions FGD with a total of 32 participants; two FGDs one for male and one for female participants were conducted in a rural and another two FGDs also one for male and one for female participants in the urban facility.
Prior to the interview, participants were informed about the nature of the study and the methods including the audio recording of the interviews. Participants were assured that the information obtained was going to be kept anonymous and confidentiality was going to be maintained.
Participants were also informed that during reporting of the of the study, quotes were going to be used with no link to their names. All participants who agreed and gave consent to participate in the study and to be audio recorded were interviewed. For the purpose of this study a cut off age of 50 years for older persons was adopted from the WHO definition [ 18 ] for those infected with HIV. Participants who were currently in care at the two participating outpatient Adult seeking casual sex Pilot Station clinics, had been followed up for at least 1 year, and were aged 50 or older at enrolling into HIV care were included in our study.
The eligible participants who did not consent to participation and audio-recording were excluded. Of the total 65 approached participants who consented to participate in our study, we interviewed The other 8 participants invited for the FGD did not turn up due to other commitments during the interview date. Two research assistants RAsrecruited from the staff at the social behavioral department within the AMPATH program, were trained by the first author to conduct the data collection.
We purposefully selected older research assistants, one female 52 years and one male 55 yearsand each was responsible for interviewing females Adult seeking casual sex Pilot Station males respectively. The choice of older RAs was informed by references in other studies [ 19 ] with older adults.
We pilot tested the in-depth interview tool in English in a peri-urban HIV care clinic to ensure the clarity of the interview questions. After necessary modifications such as deleting redundant questions and including a of new questions that arose from the pilot testing, the IDI guide Additional file 1 was then translated from English to Kiswahili.
The RAs, who were all aged above 45 years, with skills in facilitating FGDs, were referred to this study by researchers at the Department of Anthropology, Moi University. During the clinic days, research assistants reviewed the list of persons attending the clinic on that day.
The records of persons aged 50 years and above were reviewed to determine the age at first engagement in HIV care. The research assistant would then provide the clinician with the list of eligible participants clinicians had been informed about the study. The clinician would inform the research assistant as soon as the participant completed the clinic visit.
The research assistant would then approach and explain the purpose of the study to the participants. All except one participant asked to do the interview on the same day they were in the clinic and wanted it done at the health facility in which they were seeking care at. Contact details were requested for one participant for the purpose of reminder and communication before the meeting time that was scheduled. FGD participants were identified during the clinic visit, through an outreach worker stationed at the facility.
Outreach workers review files of all new patients attending HIV facility and draw the patient tracer card, including patient information and their place of residence, for future follow up if patients fail to attend clinic visits.
In the morning of the clinic day, patient files of the expected patients are pulled out. If a patient was 50 years and above at the time of initial enrolment, the file would be flagged with a yellow sticker.
After the clinic visit, the clinician would inform the research assistant who would approach the participant and explain the purpose of the study. The consent process would be done and if the participant agreed to take part, contact information was requested for further communication regarding the date, time and venue of the FGD.
During the in-depth interviews, the research assistant explained the purpose of the study and obtained written informed consent from the participant. There was a total of eight participants who were unable to read and write and a thumb print indicating their consent was obtained. The research assistant also asked whether the participant needed someone they trust to be present during the interview. None of them indicated the need for a companion. The interviews were conducted in one of the two enclosed research rooms within the clinical care space.
The room provided privacy for the participants and a quiet environment for audio-recording. Participants were then invited to narrate their experiences during HIV testing and counseling. The FGD room was set with an Adult seeking casual sex Pilot Station table that provided seats for all participants facing each other, with the facilitators sitting among them. This set up provided an opportunity for each participant to contribute to the discussion. One of the RAs facilitated the discussion while the other took notes.
Prior to the interviews, participants were informed of the purpose of the study and oral consent was obtained. All FGDs were conducted in Kiswahili and audio-recorded. The FGDs lasted between 90 and min. Data obtained from in-depth interviews and focus group discussions were transcribed verbatim, and translated from Kiswahili to English. A pre-developed codebook based on the literature on facilitators and barriers for seeking HIV testing services and accessing care was used during coding. The two RAs who conducted the IDIs and the first author coded the first three transcripts, which allowed the team to revise Adult seeking casual sex Pilot Station codebook based on the analysis of these transcripts.
The first author then shared the revised codes with the second author SH who made some recommendations to further clarify the structure of the codebook. The final codebook was agreed upon by the authors and the RAs. Thematic content analysis [ 20 ] was used to describe emerging patterns from in-depth interviews and FGDs. Recurrent themes identified and patterns established from the two data sources were summarized. Mapping and interpretation was done by searching for associations of concepts and explanations in the data. We summarize the findings according to predeveloped themes and the subthemes that emerged during the coding process.
We interviewed a total of 57 participants 25 in-depth interviews and 32 in focus group discussions with their ages ranging from 54 to 79 years. Participant characteristics are summarized in Table 1. Age and gender of the healthcare provider also mattered to older adults in seeking HIV testing services. We did not find ificant variations in experiences of older adults in urban and rural facilities hence we tly describe their experiences.
The majority of the participants indicated visits to the hospital as a main avenue to be tested for HIV. Participants described periods when they were sick and sought out-patient services or when they were admitted in hospital for other health conditions. These two strategies of HIV testing and counseling are implemented in all healthcare facilities providing inpatient and outpatient services in Kenya.
Some participants tested at the hospital setting received the HIV positive test with shock, as the following quote exemplifies:. I was really coughing and when I came to the hospital, I was admitted. They took an x-ray and they told me I have TB. It was shocking for me. I could never explain where I got it. It has never occurred to me that I could ever get it.
Unlike the participant above, another participant tested in the hospital setting was relieved that she finally knew the condition that she had been suffering from.Adult seeking casual sex Pilot Station
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