Publication Date

2016-09-15

Availability

Open access

Embargo Period

2016-09-15

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2016-08-18

First Committee Member

Joseph P. DeSantis

Second Committee Member

Victoria B. Mitrani

Third Committee Member

Jason W. Mitchell

Fourth Committee Member

Rosa M. Gonzalez-Guarda

Abstract

Couples HIV testing and counseling (CHTC) is a dyadic approach to HIV prevention which has proven to reduce transmission within couples, promote condom use and disclosure, and sustain linkages to care. Literature on providers’ perceptions about CHTC in the U.S. is lacking. This study aims to: 1) ascertain provider knowledge, attitudes and perception of CHTC, and 2) identify provider perceived challenges and facilitators of CHTC. Providers were also asked to describe current practices to engage partners to screen. A qualitative descriptive design was used to conduct in-depth, semi-structured interviews among healthcare (clinical and non-clinical) providers (N=22) in South Florida. These interviews aimed to attain their knowledge, attitude and beliefs about CHTC among their patient population. A qualitative content data analysis was conducted to develop codes, categories and themes. This was followed by a thematic analysis to explore more latent content and underlying themes from the narrative. Most HCP’s possessed a favorable attitude toward CHTC and believed it to be warranted among their patient population. Content analysis revealed that provider’s perceptions were influenced by their personal ethos and experience, their knowledge of the local context including the context of their patient vulnerabilities. The content analysis also revealed that HCP providers attitudes towards CHCT was shaped by their response to the protocol, couples consideration in providing HIV testing and care, and perceived challenges and facilitators of CHCT implementation. A thematic analysis identified four themes: Whom is this strategy for?; balanced engagement; provider experiences, practices and preferences; and the model of care and the health problem. Providers perceived the strategy to be for couples who were aiming to establish commitment or monogamy. Providers perceived that the strategy allowed for the reconceptualization of health promotion within couples and approaches between patients and providers. Current provider practices and preferences were believed to either facilitate or impede CHCT, and the model of care employed in one’s facility was perceived to either be in concordance or in discordance with the strategy aims. Providers identified a need for a paradigm shift in healthcare and medicine toward an integrative, interdisciplinary, holistic and preventative approach to disease prevention and health promotion. This shift would also ensure there is some concordance between the model of care and the health problem of interpersonal risk. Specific recommendations included the need for provider and patients education regarding interpersonal health risk; a need to refine the existing strategy protocol to include the offer of PrEP, pregnancy planning and an assessment of joint past risk behavior; and a need to streamline existing services so that partners are able to be screened for HIV if present with the index patient.

Keywords

Couples testing; HIV/AIDS; Qualitative study; metasynthesis; sexual agreements; primary methods

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