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

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 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 an-persuasion 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.