ArticleJournal of the International AIDS Society2022
Improving ART initiation among men who use HIV self-testing in Malawi: a qualitative study.
Article in Journal of the International AIDS Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 14 citations in OpenAlex.
- Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial.The Lancet. Global health · 2024Trial
- Effect of index HIV self-testing for sexual partners of clients enrolled in antiretroviral therapy (ART) programs in Malawi: A randomized controlled trial.PLoS medicine · 2023Trial
- Implementation of male-specific motivational interviewing in Malawi: an assessment of intervention fidelity and barriers to scale-up.BMJ global health · 2026Article
- Drivers of Utilization of HIV Self-Test Among Males in Malawi: A Multilevel Analysis of the Multiple Indicator Cluster Survey 2019-2020.AIDS research and treatment · 2025Article
- Developing a male-specific counselling curriculum for HIV treatment in Malawi.Gates open research · 2025Article
- Core components of male-specific person-centred HIV care: a qualitative analysis from client and healthcare worker perspectives in Malawi.BMJ public health · 2024Article
- Implementing a male-specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi.Journal of the International AIDS Society · 2024Article
- Advances in HIV self-testing: Systematic review of current developments and the road ahead in high-burden countries of Africa.SAGE open medicine · 2024Review
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Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
Abstract
introductionHIV self-testing (HIVST) increases HIV testing uptake among men; however, the linkage to antiretroviral therapy (ART) among HIVST users is low. Innovative strategies for ART initiation are needed, yet little is known about the unique barriers to care experienced by male HIVST users, and what ART-related interventions men desire.
methodsWe conducted semi-structured in-depth interviews with cisgender men (≥15 years) in Malawi who tested HIV positive using HIVST between 2018 and 2020, as well as interviews with their female partners (≥15 years) who distributed the HIVST kits. Medical records from seven facilities were used to identify respondents. We included men who received HIVST from a health facility (primary distribution) and from sexual partners (secondary distribution). Interview guides focused on unique barriers to ART initiation following HIVST and desired interventions to improve linkage and initiation. Interviews were audio recorded, translated and transcribed to English, and analysed using constant comparison methods in Atlas.ti v.8.4. Themes were compared by HIVST distribution strategy. Data were collected between 2019 and 2020.
resultsTwenty-seven respondents were interviewed: eight male/female dyads (16 respondents), eight men without a female partner and three women who represented men who did not participate in the study. Among the 19 men represented (16 men interviewed in person, three represented by secondary report from female partners), seven received HIVST through primary distribution, 12 through secondary distribution. Six men never initiated ART (all secondary HIVST distribution). Barriers to ART initiation centred on the absence of healthcare workers at the time of diagnosis and included lack of external motivation for linkage to care (men had to motivate themselves) and lack of counselling before and after testing (leaving ART-related fears and misconceptions unaddressed)--the latter was especially true for secondary HIVST distribution. Desired interventions were similar across distribution strategies and included ongoing peer mentorship for normalizing treatment adherence, counselling messages tailored to men, outside-facility services for convenience and privacy, and facility navigation to help men understand how to navigate ART clinics.
conclusionsMale HIVST users face unique challenges to ART initiation, especially those receiving HIVST through secondary distribution. Male-tailored interventions are desired by men and may help overcome barriers to care.
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