Graduate Thesis Or Dissertation
 

Examination of the Impact of HIV Stigma and Male Peers on Men’s Communication About HIV Self-Testing and the Role of mHealth in Supporting HIV Self-Testing Within Tanzania

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  • Tanzania has seen a steady decrease in HIV prevalence over the past decade; however, the current HIV prevalence is 4.8% among Tanzanian adults. HIV testing is the first step in the treatment cascade and is key to getting those living with HIV in Tanzania linked to care and reducing their risk of transmitting HIV to others. The prevalence of HIV testing particularly among Tanzanian men remains low. HIV self-test kits have the potential to improve testing among men. HIV self-testing provides a way for people to test themselves for HIV in the privacy of their own home and the self-testing kits are in the early stages of diffusion within Tanzania. The purpose of this dissertation research was to understand how HIV stigma and other factors affected a) communication about HIV testing and HIV self-testing within Tanzanian men’s social networks and b) Tanzanian men’s intent to use HIV helplines. It also aimed to understand the potential for mobile phone technology, specifically mHealth initiatives to support self-testing and linkage to care for self-test users within Sub-Saharan Africa and Tanzania. This research was conducted in two stages. The first stage used data from a randomized control trial from the Self-Testing Education and Promotion (STEP) project that examined the acceptability and feasibility of unsupervised HIV self-testing among networks of men who socialize in organized social groups (camps) in Dar es Salaam, Tanzania. The secondary data analysis, presented in Chapter 2 of this dissertation, used the baseline data to analyze how HIV stigma, demographic characteristics, and social network characteristics affected willingness to communicate about HIV testing and HIV self-testing among Tanzanian men and their close friends in person and through text messaging, and the men’s interest in using a HIV helpline and its counseling services. Results indicated that HIV stigma and male peers (peer education and perceptions of their willingness to disclose positive self-test results) affect potential communication about HIV and HIV self-testing between close friends and affect men’s intent to use a HIV hotline. The second stage of this research, presented in Chapter 3, was a scoping review that was conducted to analyze how mHealth is currently used to support HIV self-testing within Sub-Saharan Africa and the potential for mHealth-based HIV self-testing interventions in Tanzania to improve HIV self-testing. Results indicated that mHealth interventions can prove beneficial in increasing self-testing and supporting users through the self-testing process within Sub-Saharan Africa. However, the current evidence base for the use of mHealth to support HIV self-testing within Sub-Saharan Africa is relatively small and more high-quality research is needed for mHealth to aid in the diffusion of HIV self-tests within Sub-Saharan Africa and specifically Tanzania.
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