{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:07:11Z","timestamp":1791832031209,"version":"4.3.4"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T00:00:00Z","timestamp":1624924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH-NICHD","award":["R01H070767-01"],"award-info":[{"award-number":["R01H070767-01"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>HIV status awareness is critical for HIV prevention and care but HIV testing rates remain low in Uganda, especially among men. One suggested approach to increase access and utilisation of HIV testing services is HIV self-testing. We explored perceptions of pregnant and lactating women and their male partners who attended antenatal care, and health care providers in a government hospital in Kampala, Uganda, about HIV self-testing for initial or repeat testing for women and their partners during pregnancy and postpartum We draw implications for scaling-up this new testing approach in Uganda.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a qualitative study conducted at Mulago National Referral Hospital, Kampala, Uganda, between April and December 2017. We conducted in-depth interviews with five pregnant or lactating women and their five male partners; five focus group discussions (two with women, two with health workers and one with male partners of women attending antenatal care) and five key informant interviews with health workers providing prevention of mother-to-child HIV transmission (PMTCT) services. Data were analysed using content thematic approach.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There was limited awareness about HIV self-testing especially among pregnant or lactating women and their male partners. Study participants mentioned that HIV self-testing would enable people to know their HIV status faster, they thought the approach would be cost- and time-saving compared to health facility-based HIV testing, improve confidentiality and reduce stigma for those who test HIV positive. They expressed however, a general fear that HIV self-testing would lead to harm to self and others in case one tested HIV positive, including suicide, violence among couples, intentional transmission of HIV, and limited linkage to care due to lack of counselling. The likely misinterpretation of HIV test results especially among those with no or limited education, and possible coercion exerted by male partners on their wives were other potential concerns raised about the use of HIV self-testing.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>There was limited knowledge about HIV self-testing among pregnant and lactating women, their partners and health workers. While the self-testing modality was perceived to be critical for helping people, especially those in casual and distant relationships, to know their HIV status and that of their partners, most study participants believed that HIV self-testing could potentially result in a multitude of negative outcomes in the absence of pre- and post-test counselling. Successful scale-up and integration of self-testing in HIV programs requires community education, provision of information materials and making self-test kits accessible and affordable, especially in rural areas.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0253616","type":"journal-article","created":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T17:38:17Z","timestamp":1624988297000},"page":"e0253616","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pregnant women, their male partners and health care providers\u2019 perceptions of HIV self-testing in Kampala, Uganda: Implications for integration in prevention of mother-to-child transmission programs and scale-up"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9485-8790","authenticated-orcid":true,"given":"Joseph","family":"Rujumba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaco","family":"Homsy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6436-3431","authenticated-orcid":true,"given":"Femke Bannink","family":"Mbazzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zikulah","family":"Namukwaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Amone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Rukundo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elly","family":"Katabira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josaphat","family":"Byamugisha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Glenn","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,6,29]]},"reference":[{"key":"pone.0253616.ref001","unstructured":"UNAIDS: UNAIDS report on the Global AIDS epidemic 2013."},{"key":"pone.0253616.ref002","unstructured":"WHO, UNAIDS: Report on the first international symposium on self-testing for HIV: The legal, ethical, gender, human rights and public health implications of self-testing scale-up Meeting report In. Geneva, Switzerland; 2013."},{"key":"pone.0253616.ref003","unstructured":"Collin Mangenah, L. Mwenge, L. Sande, E. Sibanda, P. Chiwawa, T. Chigwenah, et al: The cost of community based HIV self test (HIVST) kit distribution: Results from three districts in Zimbabwe In.: UNITAID PSI HIV Self Testing Africa; Undated."},{"key":"pone.0253616.ref004","unstructured":"World Health Organization: Policy brief: WHO recommends HIV self-testing. In.; 2016."},{"key":"pone.0253616.ref005","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1007\/s10461-015-1097-8","article-title":"Rachel Baggaley: Attitudes and Acceptability on HIV Self-testing Among Key Populations: A Literature Review","volume":"19","author":"Carmen Figueroa","year":"2015","journal-title":"AIDS Behaviour"},{"issue":"4","key":"pone.0253616.ref006","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/s10461-014-0817-9","article-title":"Factors shaping initial decision-making to self-test amongst cohabiting couples in urban Blantyre, Malawi","volume":"18","author":"M Kumwenda","year":"2014","journal-title":"AIDS and Behavior"},{"issue":"12","key":"pone.0253616.ref007","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1007\/s10461-014-0765-4","article-title":"Accuracy of un-su- pervised versus provider-supervised self-administered hiv testing in Uganda: a randomized implementation trial","volume":"18","author":"S Asiimwe","year":"2014","journal-title":"AIDS Behaviour"},{"issue":"10","key":"pone.0253616.ref008","doi-asserted-by":"crossref","first-page":"e1001102","DOI":"10.1371\/journal.pmed.1001102","article-title":"The uptake and accu- racy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi","volume":"8","author":"AT Choko","year":"2011","journal-title":"Plos Medicine"},{"issue":"Suppl 4","key":"pone.0253616.ref009","doi-asserted-by":"crossref","first-page":"S405","DOI":"10.1007\/s10461-014-0830-z","article-title":"Factors associated with acceptability of HIV self-testing among health care workers in Kenya","volume":"18","author":"S Kalibala","year":"2014","journal-title":"AIDS Behaviour"},{"issue":"5","key":"pone.0253616.ref010","doi-asserted-by":"crossref","first-page":"318","DOI":"10.3390\/diagnostics10050318","article-title":"Costs of Providing HIV Self-Test Kits to Pregnant Women Living with HIV for Secondary Distribution to Male Partners in Uganda","volume":"10","author":"MA Bulterys","year":"2020","journal-title":"Diagnostics"},{"issue":"3","key":"pone.0253616.ref011","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/QAI.0000000000002341","article-title":"HIV Oral self-testing for male partners of women attending antenatal care in central Uganda: uptake of testing and linkage to care in a randomized trial","volume":"84","author":"JE Korte","year":"2020","journal-title":"JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"issue":"4","key":"pone.0253616.ref012","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/QAI.0000000000002347","article-title":"Is HIV self-testing a strategy to increase repeat testing among pregnant and postpartum women? 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In.: MOH, Kampala, Uganda; 2017."},{"issue":"1","key":"pone.0253616.ref027","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/1472-6963-13-189","article-title":"Pregnant women\u2019s experiences of routine counselling and testing for HIV in Eastern Uganda: a qualitative study","volume":"13","author":"J Rujumba","year":"2013","journal-title":"BMC health services research"},{"issue":"2","key":"pone.0253616.ref028","doi-asserted-by":"crossref","first-page":"17429","DOI":"10.7448\/IAS.15.2.17429","article-title":"\u201cTelling my husband I have HIV is too heavy to come out of my mouth\u201d: pregnant women\u2019s disclosure experiences and support needs following antenatal HIV testing in eastern Uganda","volume":"15","author":"J Rujumba","year":"2012","journal-title":"Journal of the International AIDS Society"},{"key":"pone.0253616.ref029","doi-asserted-by":"crossref","first-page":"S422","DOI":"10.1007\/s10461-014-0818-8","article-title":"What Should the Ideal HIV Self-Test Look Like? 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In. Geneva; 2014."},{"issue":"50","key":"pone.0253616.ref034","article-title":"HIV self-testing practices among Health Care Workers: feasibility and options for accelerating HIV testing services in Ethiopia","volume":"15","author":"Bekana Kebede","year":"2013","journal-title":"Pan African Medical Journal"},{"issue":"8","key":"pone.0253616.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0183280","article-title":"HIV self-testing values and preferences among sex workers, fishermen, and mainland community members in Rakai, Uganda: a qualitative study","volume":"12","author":"VM Burke","year":"2017","journal-title":"PLoS One"},{"issue":"2","key":"pone.0253616.ref036","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1007\/s10461-017-1783-9","article-title":"Offering self-administered oral HIV testing as a choice to truck drivers in Kenya: predictors of uptake and need for guidance while self-testing","volume":"22","author":"EA Kelvin","year":"2018","journal-title":"AIDS and Behavior"},{"issue":"1","key":"pone.0253616.ref037","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12889-018-6366-9","article-title":"HIV self-testing as part of a differentiated HIV testing approach: exploring urban and rural adult experiences from KwaZulu-Natal, South Africa using a cross-over study design","volume":"19","author":"C Harichund","year":"2019","journal-title":"BMC public health"},{"key":"pone.0253616.ref038","unstructured":"Uganda Bureau of Statistics: Uganda Statistical Abstract. In.: UBOS, Kampala, Uganda; 2019."},{"issue":"13","key":"pone.0253616.ref039","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1177\/0956462417705800","article-title":"\u2018\u2026 if you bring the kit home, you [can] get time and test together with your partner\u2019: Pregnant women and male partners\u2019 perceptions regarding female partner-delivered HIV self-testing in Uganda\u2013A qualitative study","volume":"28","author":"JK Matovu","year":"2017","journal-title":"International journal of STD & AIDS"},{"issue":"1","key":"pone.0253616.ref040","doi-asserted-by":"crossref","first-page":"19445","DOI":"10.7448\/IAS.18.1.19445","article-title":"What are the constraints and opportunities for HIVST scale\u2010up in Africa? 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