Clients' and providers' perspectives in informing a digital health intervention to improve linkage to care after Index HIV self-testing in Hai and Moshi Districts, Tanzania

Frank Mhando, Johannesburg Business School, University of Johannesburg, Johannesburg, South Africa. frank.mhando@gmail.com.
Stella E. Mushy, Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Marwa Nyankomo, Johannesburg Business School, University of Johannesburg, Johannesburg, South Africa.
Frederick Haraka, Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
Werner Maokola, Ministry of Health, Dodoma, Tanzania.
Zeye Masunga, Ministry of Health, Dodoma, Tanzania.
Thomas Machalo, Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
Catherine Nnko, Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
Michelle M. Gill, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
Sajida Kimambo, Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
Samuel Janson, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Samara Toussaint, University of Maryland, College Park, MD, USA.
Marie J. Bourgeau, Empire State College, Staten Island, NY, USA.
Mamaswatsi Kopeka, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Ivan Teri, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
Christa Hall, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Zhao Ni, Yale University School of Nursing, New Haven, CT, USA.
Genae Hatcher, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Mgolegrace S. Mabusi, Kilimanjaro Christian Medical University, Moshi, Tanzania.
Donaldson F. Conserve, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.

Document Type

Journal Article

Publication Date

9-17-2024

Journal

BMC health services research

Volume

24

Issue

1

DOI

10.1186/s12913-024-11466-2

Keywords

Digital health; Digital health intervention; HIV self-testing (HIVST); Linkage to HIV care

Abstract

BACKGROUND: Digital health interventions have the potential to improve linkage to care after HIV self-testing (HIVST). This study aimed to understand clients' and providers' perceptions of benefits, and barriers of a digital health intervention designed to improve linkage to care after HIV self-testing in Tanzania. METHODS: This exploratory qualitative research study was conducted in Hai and Moshi, districts in Kilimanjaro region, Tanzania. Four health facilities were selected based on their involvement in an HIVST pilot program implemented by Elizabeth Glassier Pediatric AIDS Foundation (EGPAF) Tanzania through the USAID funded program. The study included female index clients and their partners, and healthcare providers at the healthcare facilities. We used a semi-structured interview guide with open-ended questions for data collection. Data collection was conducted from 16th January 2023 to 3rd February 2023. Thematic analysis of the qualitative data was conducted, guided by the Health Belief Model (HBM), and results were developed in collaboration with the community partners. RESULTS: A total of 42 participants were included in the study, comprising 9 male clients, 17 female index clients, and 16 health care workers (HCWs) (4 male and 12 female) who were involved in delivering HIVST services. The study's findings revealed mixed feelings about the use of a digital health intervention. Majority of participants perceived digital health as a valuable intervention for enhancing linkage to care, improved health outcomes, improved communication with healthcare workers, and increased privacy. Therefore, they supported scale-up of a digital health intervention. Participants also expressed that the potential benefits of a digital health intervention include the convenience of accessing healthcare services from the comfort of their homes or any location. However, a few participants expressed concerns about potential risks associated with sending health-related text messages. They feared that recipients might not be in a safe space, leading to stigma and avoidance of engagement. A few female participants expressed concerns about confidentiality breaches, particularly regarding shared phones with family or friends. Fear of being judged or misunderstood by others could deter them from reading or acting upon these messages. Most participants recommended tailored strategies that prioritize confidentiality and trust. Recognizing these psychological aspects is vital for customizing digital health interventions to effectively address participants' concerns. CONCLUSIONS: Digital health interventions may improve the linkage of HIV self-testers to care. Recommendations include personalized and culturally relevant communication and technical accessibility to make interventions effective and inclusive. This study provides valuable insights for designing patient-centered interventions for HIV care and treatment.

Department

Prevention and Community Health

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