@article{75615f1b9e61450fbdb274e220bd4c30,
title = "Understanding the role of interpersonal violence in assisted partner notification for HIV: a mixed-methods study in refugee settlements in West Nile Uganda",
abstract = "Background Assisted partner notification (APN) for HIV was introduced in refugee settlements in West Nile Uganda in 2018 to facilitate testing of sexual partners. While APN is an effective strategy recommended by the World Health Organization, its safety has not been evaluated in a refugee settlement context in which participants have high prior exposure to interpersonal violence. The extent to which interpersonal violence influences APN utilization and the frequency with which post-APN interpersonal violence occurs remains unknown.Methods To explore the relationship between APN and interpersonal violence, a cross-sectional mixed-methods study was conducted at 11 health centers in refugee settlements in West Nile Uganda. Routinely collected index client and sexual partner data were extracted from APN registers and semi-structured interviews were conducted with health workers.Results Through APN, 1126 partners of 882 distinct index clients were identified. For 8% (75/958) of partners, index clients reported a history of intimate partner violence (IPV). For 20% (226/1126) of partners, index clients were screened for post-APN IPV; 8 cases were reported of which 88% (7/8) concerned partners with whom index clients reported prior history of IPV. In qualitative interviews (N = 32), health workers reported HIV disclosure-related physical, sexual and psychological violence and deprivation or neglect. Incidents of disclosure-related violence against health workers and dependents of index clients were also reported. Fear of disclosure-related violence was identified as a major barrier to APN that prevents index clients from listing sexual partners.Conclusions Incidents of interpersonal violence have been reported following HIV-disclosure and fear of interpersonal violence strongly influences APN participation. Addressing HIV perception and stigma may contribute to APN uptake and program safety. Prospective research on interpersonal violence involving index clients and sexual partners in refugee settlements is needed to facilitate safe engagement in APN for this vulnerable population.",
keywords = "POSTTRAUMATIC-STRESS-DISORDER, TO-CHILD TRANSMISSION, MENTAL-HEALTH, WOMEN, SERVICES, PREVENTION, PROGRAM, RISK, EXPERIENCES, COUNTRIES",
author = "Klabbers, {Robin E.} and Muwonge, {Timothy R.} and Emmanuel Ayikobua and Diego Izizinga and Ingrid Bassett and Andrew Kambugu and Tsai, {Alexander C.} and Miranda Ravicz and Gonnie Klabbers and O'Laughlin, {Kelli N.}",
note = "Funding Information: Acknowledgements: We express our gratitude to the Infectious Diseases Institute (IDI) at Makerere University for its partnership and for offering the support of its teams and use of its health infrastructure in West Nile. We want to extend our thanks to all interview participants who gave up their time to share their experiences with us. Written informed consent was obtained from all interview participants included in the study and all interview participants signed informed consent regarding publishing of interview study data. Funding: This work was supported by the National Institute of Mental Health (K23MH108440 and K24AI141036). This funding body did not participate in study design, implementation, data analysis, data interpretation or writing of this manuscript. Authorship contributions: KNO, REK, and TRM conceived and designed the study. DI offered consultation on aspects of the research related to interpersonal violence. KNO, REK, and TRM obtained necessary approvals. REK led efforts on data collection supported by EA with supervision from KNO and TRM. KNO, REK, and TRM reviewed the data and conducted data analysis with statistical support from GK. REK wrote the first draft of the manuscript together with KNO. IVB, ACT, MR, TRM, GK, AK, DI and EA reviewed the manuscript, provided useful input and feedback and revised it critically for important intellectual content. All authors assisted with final revisions and approved the final version of the manuscript. Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest. Funding Information: Acknowledgements: We express our gratitude to the Infectious Diseases Institute (IDI) at Makerere University for its partnership and for offering the support of its teams and use of its health infrastructure in West Nile. We want to extend our thanks to all interview participants who gave up their time to share their experiences with us. Written informed consent was obtained from all interview participants included in the study and all interview participants signed informed consent regarding publishing of interview study data. Funding: This work was supported by the National Institute of Mental Health (K23MH108440 and K24AI141036). This funding body did not participate in study design, implementation, data analysis, data interpretation or writing of this manuscript. Authorship contributions: KNO, REK, and TRM conceived and designed the study. DI offered consultation on aspects of the research related to interpersonal violence. KNO, REK, and TRM obtained necessary approvals. REK led efforts on data collection supported by EA with supervision from KNO and TRM. KNO, REK, and TRM reviewed the data and conducted data analysis with statistical support from GK. REK wrote the first draft of the manuscript together with KNO. IVB, ACT, MR, TRM, GK, AK, DI and EA reviewed the manuscript, provided useful input and feedback and revised it critically for important intellectual content. All authors assisted with final revisions and approved the final version of the manuscript.",
year = "2020",
month = dec,
doi = "10.7189/jogh.10.020440",
language = "English",
volume = "10",
journal = "Journal of Global Health",
issn = "2047-2978",
publisher = "Edinburgh University Global Health Society",
number = "2",
}