Barcelona 2013 Barcelona, Catalonia, Spain 2013
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Abstract #2727  -  New technology is good, because people don't like blood taking. A qualitative study assessing the acceptability and feasibility of outreach HIV-testing using oral fluid collection devices among sub-Saharan African migrants
  Presenting Author:   Ms Jasna Loos - Institute of Tropical Medicine
  Additional Authors:  Ms Fiona Namanya, Dr Lazare Manirankunda, Ms Laura Albers, Ms Tine Vermoesen, Mr Tom Platteau, Dr Katrien Fransen, Dr Christiana Nöstlinger,  
Half of sub-Saharan African migrants (SAM) in Belgium are diagnosed late. Outreach HIV-testing using novel technologies can play a key role in its reduction. The "swab2know" intervention used oral fluid collection devices and offered a choice between result collection through a secured website or consulting an HIV-testing center. Testing sessions in SAM community settings, included an informational speech and a testimony of a SAM living with HIV. To assess the feasibility and acceptability of this intervention, we conducted participant observations.
  Method / Issue:
Between December 2012 and June 2013 we attended 10 sessions (one café, two churches and seven community events organized by o.a. an African LGBT, a youth- and women's group). 143 descriptive notes of informal interviews and observations were coded using N-VIVO-10 and thematically analyzed.
  Results / Comments:
About 800 SAM were present in the settings. 142 tested and with 43 we had an informal interview. We also had talked to 67 non-participants and the intervention team after each session. Acceptance of outreach HIV-testing was linked with prior HIV-awareness raising and community ownership. In communities acquainted with HIV-prevention activities, eg. the Congolese- and LGBT-communities, and when leaders had sensitized their members upfront, the intervention was positively appreciated and testing uptake high. In other settings, the audience was more cautious. Some questioned the appropriateness of HIV-testing at cultural celebrations or parties, others feared social control or doubted the present audience to be a target group for HIV-testing. All 5 cases indicative for a positive HIV-result were from settings with lower acceptance. Motivation for testing was often expressed through statements like "it is good to know". Participants said the team's presence reminded them of the need to test and they felt encouraged by the testimony. Participants wanted to benefit from the opportunity to get a free test without having to visit a physician. In a few cases, peer-, community- or partner pressure were at play. Non-participants often referred to a previous HIV-test, sometimes assuming they already had been tested: "my doctor never mentioned anything". Low personal sexual risk was also a reason for refusal, men giving risk assessments of their girlfriends, women mentioning consistent condom use. The oral fluid testing devices were perceived as lowering thresholds compared to undesirable "blood draining". The test kits were found easy in use and painless. The method raised some questions about possible HIV-transmission via saliva. 77 participants (54.2%) chose to collect their results from the website, mostly because it was found more convenient than consulting the HIV-testing center. Some added ?the website is oké, because I don?t have anything?. It also enabled participation of SAM living abroad. Participants who chose the testing center had no Email address or internet access, or preferred professional support.
Outreach HIV-testing using oral fluid collection devices is feasible and acceptable, but it cannot disregard the barriers to HIV-testing prevalent in the SAM communities. To be successful, interventions should be embedded in broader HIV-prevention campaigns and community ownership must be assured when preparing implementation. A testimony by an HIV-positive community member is an important booster.
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