Family–Based Index Testing for HIV: a qualitative study of barriers and challenges among clients in Cape Coast, Ghana

Abstract

Background Family-based Index HIV Testing, (FBIT) approach is known to be associated with a relatively higher testing yield compared to Provider-Initiated Testing and Counseling. The implementation of this strategy in several countries has exposed some barriers to optimal FBIT outcomes. With the scale up of FBIT in Ghana, stakeholders’ engagement is key in identifying and addressing all barrier to implementation. This study explored index clients’ perspective of barriers and challenges of FBIT. Methods Using an exploratory descriptive qualitative design, 17 individual in-depth interviews were conducted among seventeen purposively selected clients who had been offered FBIT at the Cape Coast Teaching Hospital (CCTH) utilizing a semi-structured interview guide. Each interview lasted between 45–60 minutes and the transcripts were transcribed verbatim and analyzed using qualitative content analysis procedure. Themes and sub-themes from the transcripts were generated and supported with verbatim texts to provide a rich understanding of the barriers and challenges. Results Age of participants ranged between 24–71 years, majority of whom were females. Themes and subthemes emerged on barriers and challenges and these related to good understanding of the benefits of FBIT by index clients, challenge with getting family members to accept testing opportunities, fear and uncertainty of reaction of family members to a positive status, and issues of confidentiality and privacy related to health facility service provision. Key findings were: 1. Index clients perceived FBIT as a good approach to reach family members for testing. 2. Stigmatization, lack of confidentiality and privacy at service centers and 3. Inadequate information on FBIT were identified as barriers that can affect the uptake of FBIT. Getting listed family members to agree to be tested was perceived as a challenge. Conclusions Despite the acceptance of FBIT as a good strategy to reach family members of index clients for testing, there are barriers of stigmatization, fear and uncertainty of reaction of family members to a positive status, lack of confidentiality and privacy, and inadequate information on FBIT. Efforts should be made to address these barriers and challenges. Index clients and their families need tailored support to improve acceptance of this strategy.