Acknowledgements

We would like to thank all of the participants who contributed their time and thoughtful responses to this study. We thank the Rakai Health Sciences Program leadership team, administrative team, and qualitative data collection team who enabled this study to happen.

We acknowledge and appreciate funding for this work from the World Health Organization, Department of HIV/AIDS. We also appreciate funding for Ms. Burke’s and Ms. Hutchinson’s time and travel from the Johns Hopkins Center for Global Health Established Field Placement Awards. This research was funded in part by a 2014 developmental grant from the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. Finally, this research was also funded in part by an R01 from the National Institute of Mental Health (NIMH) (R01MH105313). The content is solely the responsibility of the authors and does not necessarily represent the official views of WHO or the NIH.

Finally, many thanks to all those who reviewed the draft report and provided valuable feedback: Virginia Burke, Naadiya Hutchinson, Caitlin Payne (Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program), Neema Nakyanjo, William Ddaaki, Fred Nalugoda (Rakai Health Sciences Program, Kalisizo, Uganda), Rachel Baggaley, Cheryl Johnson, Carmen Figueroa and Shona Dalal (WHO-Geneva).

26.1. Background

HIV partner notification, also known as assisted partner services or contact tracing, involves contacting the sexual partners of people who test HIV-positive to link people at heightened HIV risk to testing services, treatment, and prevention. As partner notification programs expand across sub-Saharan Africa, organizations must consider community perceptions and preferences to design acceptable, effective programs. We conducted a qualitative study to understand values and preferences around HIV partner notification in Rakai, Uganda

26.2. Methodology

Sixty three in-depth interviews were conducted, with 20 health care providers and 43 community members in both high-risk fishing communities (including sex workers and fishermen) and low-risk rural mainland communities. We also conducted 6 focus group discussions (FGDs). Questions explored specific approaches to partner notification, including passive referral (self-disclosure), provider referral (anonymous provider-led notification), and contract referral (provider-led notification after a period for self-disclosure). Interviews and FGDs were conducted in Luganda or English and audio-recorded after obtaining written informed consent. Qualitative data were translated, transcribed, coded, and analyzed using a team-based matrix approach. 26.3 Results

26.3. Results

Participants generally supported partner notification programs. Sex workers, fishermen, and health care providers agreed that passive referral is most effective for married couples or those in close, intimate relationships. Mainland community members felt contract referral was also acceptable for married couples. Provider referral was preferred for individuals with multiple, casual partners and was highly acceptable among sex workers and fishermen. Anonymous provider referral appealed to sex workers and fishermen, though participants worried provider involvement might encourage skepticism and rumors. Health care providers voiced concerns about limited time, resources, and training for provider-assisted approaches.

26.4. Interpretation

We found generally positive views of partner notification programs, with different approaches meeting the needs of different groups and for different relationship types. The anonymity of provider-assisted partner notification may help people overcome the social and economic barriers to HIV serostatus disclosure. Findings suggest that a range of services may help expand HIV services to high-risk individuals in this setting