Table_2_Enthusiasm for Introducing and Integrating HIV Self-Testing but Doubts About Users: A Baseline Qualitative Analysis of Key Stakeholders' Attitudes and Perceptions in Côte d'Ivoire, Mali and Senegal.DOCX

Since 2019, the ATLAS project, coordinated by Solthis in collaboration with national AIDS programs, has introduced, promoted and delivered HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal. Several delivery channels have been defined, including key populations: men who have sex with men, female sex workers and people who use injectable drugs. At project initiation, a qualitative study analyzing the perceptions and attitudes of key stakeholders regarding the introduction of HIVST in their countries and its integration with other testing strategies for key populations was conducted. The study was conducted from September to November 2019 within 3 months of the initiation of HIVST distribution. Individual interviews were conducted with 60 key informants involved in the project or in providing support and care to key populations: members of health ministries, national AIDS councils, international organizations, national and international non-governmental organizations, and peer educators. Semi structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose© software for thematic analyses. We found that stakeholders' perceptions and attitudes are favorable to the introduction and integration of HIVST for several reasons. Some of these reasons are held in common, and some are specific to each key population and country. Overall, HIVST is considered able to reduce stigma; preserve anonymity and confidentiality; reach key populations that do not access testing via the usual strategies; remove spatial barriers; save time for users and providers; and empower users with autonomy and responsibility. It is non-invasive and easy to use. However, participants also fear, question and doubt users' autonomy regarding their ability to use HIVST kits correctly; to ensure quality secondary distribution; to accept a reactive test result; and to use confirmation testing and care services. For stakeholders, HIVST is considered an attractive strategy to improve access to HIV testing for key populations. Their doubts about users' capacities could be a matter for reflective communication with stakeholders and local adaptation before the implementation of HIVST in new countries. Those perceptions may reflect the West African HIV situation through the emphasis they place on the roles of HIV stigma and disclosure in HIVST efficiency.

自2019年起，由Solthis协调、并与各国艾滋病防治项目合作推进的ATLAS项目，在科特迪瓦、马里和塞内加尔引入、推广并落地了艾滋病自我检测（HIV self-testing, HIVST）服务。该项目明确了多类投放渠道，覆盖关键人群（key populations）：男男性行为者（men who have sex with men）、女性性工作者（female sex workers）及注射吸毒人群（people who use injectable drugs）。项目启动之初，研究团队开展了一项定性研究（qualitative study），分析关键利益相关方（key stakeholders）对在本国引入艾滋病自我检测，并将其与针对关键人群的其他检测策略进行整合的认知与态度，该研究于2019年9月至11月开展，即在艾滋病自我检测物资分发启动后的3个月内完成。研究共对60名关键信息提供者（key informants）开展了个人访谈（individual interviews），这些受访者要么参与项目，要么为关键人群提供支持与照护，包括卫生部门工作人员、国家艾滋病委员会成员、国际组织人员、国内外非政府组织成员及同伴教育者。半结构化访谈（semi-structured interviews）全程录音，必要时进行翻译并转录为文本，研究团队使用Dedoose©软件对数据进行编码，以开展主题分析（thematic analyses）。研究结果显示，多数利益相关方对艾滋病自我检测的引入及整合持支持态度，背后存在多重动因：其中部分动因具有普适性，部分则因不同关键人群与国家而异。总体而言，各方认为艾滋病自我检测可有效减少艾滋病污名（stigma），保护匿名性与保密性，覆盖传统检测渠道无法触及的关键人群，消除空间壁垒，为受检者与服务提供者节省时间，并提升受检者的自主意识与责任意识；该检测方式无创且操作简便。但同时，受访对象也存在诸多顾虑：他们担忧受检者能否正确使用艾滋病自我检测试剂盒、能否保障后续二次分发的质量、能否坦然接受阳性检测结果（reactive test result），以及能否及时前往确认检测（confirmation testing）与后续照护服务机构。对利益相关方而言，艾滋病自我检测是提升关键人群艾滋病检测可及性的一项极具吸引力的方案。在向新国家推广艾滋病自我检测前，相关方可通过与利益相关方开展反思性沟通、结合本地场景进行适配调整，来打消对受检者能力的疑虑。受访对象对艾滋病污名与信息披露在艾滋病自我检测有效性中的作用的重视，或可反映西非地区的艾滋病防控现状。