Title

Dissatisfaction with general health services is negatively associated with uptake of HIV testing among men in Malawi: a community-representative survey

Presenter

Marguerite Thorp

Authors

M. Thorp¹, K. Balakasi², S. Khan³, C. Stillson⁴, J.J. van Oosterhout², B.E. Nichols³, M. Cornell⁵, K. Dovel^1,2

Institutions

¹University of California Los Angeles, Division of Infectious Diseases, Los Angeles, United States, ²Partners in Hope, Lilongwe, Malawi, ³FIND, the Global Alliance for Diagnostics, Geneva, Switzerland, ⁴Clinton Health Access Initiative, Washington, DC, United States, ⁵University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa

BACKGROUND: Across sub-Saharan Africa, men are less likely to know their HIV status than women, leading to later treatment initiation and higher HIV-related morbidity and mortality. Negative experiences with HIV services are qualitatively shown to discourage men's future use of HIV services, however little is known about how experiences with general health services affect men's use of HIV testing. This question is important as national programs further integrate HIV and general health services and seek to understand men's health holistically.
METHODS: We used data from a 2019 community-representative survey of men in Malawi to understand frequency and cause of men's negative health service experiences (defined as men reporting they “would not recommend” a facility, or “WNR” experiences) and their association with men's future HIV testing. We conducted univariable and multivariable logistic regressions to determine which aspects of health facility visits were associated with WNR experiences and to determine if WNR experiences 12-24 months prior to the survey were associated with HIV testing uptake in the 12 months prior to the survey.
RESULTS: We included 1,098 men who were eligible for HIV testing in the 12 months prior to the survey. Median age was 34 years; 75% were married; 21% had attended secondary school. Of 3,805 health service visits reported, 10% were for HIV-related services. 9% of men reported at least one WNR experience, which did not differ by men's sociodemographics, gender norm beliefs, or HIV stigma beliefs. The factors most strongly associated with WNR experiences were cost (aOR 5.8, 95%CI 2.9-11.4), cleanliness (aOR 4.2, 95%CI 1.8-9.9), medicine availability (aOR 3.3, 95%CI 1.7-6.4), and wait times (aOR 2.7, 95%CI 1.5-5.0). Reporting a WNR experience was associated with a 59% decrease in likelihood of testing for HIV (aOR 0.41; 95% CI:0.17-0.96).
CONCLUSIONS: Dissatisfaction with general health services was strongly associated with reduced HIV testing among men in Malawi. Findings suggest men do not segregate their health service experiences and may reduce use of HIV services in response to negative experiences with other services. Coverage of high-priority screening services like HIV testing among Malawian men may benefit from improving overall health system quality.

Download the e-Poster (PDF)