Organisation of testing services, structural barriers and facilitators of routine HIV self-testing during sexually transmitted infection consultations: a qualitative study of patients and providers in Abidjan, Côte d’Ivoire
Authors: Boye Sokhna , Kouadio Alexis , Kouvahe Amélé Florence , Vautier Anthony , Ky-Zerbo Odette , Rouveau Nicolas , Maheu-Giroux Mathieu , Silhol Romain , Simo Fotso Arlette , Larmarange Joseph , Pourette Dolorès ,   for ATLAS team, Elvis Georges Amani , Badiane Kéba , Bayac Céline , Bekelynck Anne , Boily Marie-Claude , Breton Guillaume , d’Elbée Marc , Desclaux Alice , du Loû Annabel Desgrées , Papa Moussa Diop , Doumenc-Aïdara Clémence , Ehui Eboi , Graham Medley , Jean Kévin , Keita Abdelaye , Kra Arsène Kouassi , Medley Graham , Moh Raoul , Cheikh Tidiane Ndour , Terris-Prestholt Fern , Métogara Mohamed Traore , Diallo Sanata , Papa Alioune Gueye , Geoffroy Olivier , Kabemba Odé Kanku , Abokon Armand , Anoma Camille , Diokouri Annie , Kouame Blaise , Kouakou Venance , Koffi Odette , Kpolo Alain-Michel , Tety Josiane , Traore Yacouba , Bagendabanga Jules , Berthé Djelika , Diakite Daouda , Diakité Mahamadou , Diallo Youssouf , Daouda Minta , Hessou Septime , Kanambaye Saidou , Kanoute Abdul Karim , Keita Dembele Bintou , Koné Dramane , Koné Mariam , Maiga Almoustapha , Nouhoum Telly , Sanogo Abdoulaye , Saran Keita Aminata , Sidibé Fadiala , Tall Madani , Yattassaye Camara Adam , Bâ Idrissa , Papa Amadou Niang Diallo , Fall Fatou , NDèye Fatou NGom Guèye , Ndiaye Sidy Mokhtar , Niang Alassane Moussa , Samba Oumar , Thiam Safiatou , Turpin Nguissali M. E. , Bouaré Seydou , Camara Cheick Sidi , Eponon Ehua Agnes , Montaufray Marie-Anne , Mosso Rosine , Ndeye Pauline Dama , Sarrassat Sophie , Sow Souleymane 
Published: February 2024

Abstract
Background
Consultations for sexually transmitted infection (STI) provide an opportunity to offer HIV testing to both patients and their partners. This study describes the organisation of HIV self-testing (HIVST) distribution during STI consultations in Abidjan (Côte d’Ivoire) and analyse the perceived barriers and facilitators associated with the use and redistribution of HIVST kits by STI patients.

Materials and methods
A qualitative study was conducted between March and August 2021 to investigate three services providing HIVST: an antenatal care clinic (ANC), a general health centre that also provided STI consultations, and a dedicated STI clinic. Data were collected through observations of medical consultations with STI patients (N = 98) and interviews with both health professionals involved in HIVST distribution (N = 18) and STI patients who received HIVST kits for their partners (N = 20).

Results
In the ANC clinic, HIV testing was routinely offered during the first prenatal visit. HIVST was commonly offered to women who had been diagnosed with an STI for their partner’s use (27/29 observations). In the general health centre, two parallel pathways coexisted: before the consultation, a risk assessment tool was used to offer HIV testing to eligible patients and, after the consultation, patients who had been diagnosed with an STI were referred to a care assistant for HIVST. Due to this HIV testing patient flow, few offers of HIV testing and HIVST were made in this setting (3/16). At the dedicated STI clinic, an HIVST video was played in the waiting room. According to the health professionals interviewed, this video helped reduce the time required to offer HIVST after the consultation. Task-shifting was implemented there: patients were referred to a nurse for HIV testing, and HIVST was commonly offered to STI patients for their partners’ use (28/53). When an HIVST was offered, it was generally accepted (54/58). Both health professionals and patients perceived HIVST positively despite experiencing a few difficulties with respect to offering HIVST to partners and structural barriers associated with the organisation of services.

Conclusion
The organisation of patient flow and task-shifting influenced HIV testing and offers of HIVST kits. Proposing HIVST is more systematic when HIV testing is routinely offered to all patients. Successful integration requires improving the organisation of services, including task-shifting.