Facilitators and Barriers to Community-Based HIV Testing in Guinea: A CFIR-Based Implementation Analysis

Soriba CAMARA^1*Tamba Mina MILLINOUNO²Mory 1 KOUROUMA³Abdoulaye SOW²SIDIKIBA SIDIBE²Aly Badara TOURE²Aly Badara NABE²Alexandre DELAMOU²

• ¹Gamal Abdel Nasser University of Conakry, Conakry, Equatorial Guinea
• ²Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Equatorial Guinea
• ³Center of Research and Training in Infectious Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea

In Guinea, where 36% of people living with HIV (PLHIV) are unaware of their serostatus, innovative screening strategies are crucial to achieving the joint United Nations Program on HIV/AIDS' 95-95-95 targets. Community-based HIV testing, as recommended by the World Health Organization, aims to reach at-risk populations by leveraging local resources and actors. Using the Consolidated Framework for Implementation Research (CFIR), this study assessed facilitators and barriers to implementing community-based HIV screening across ten pilot sites in Guinea, with the goal to optimizing e its effectiveness.This qualitative descriptive study applied the CFIR framework to identify factors influencing the implementation of community-based HIV screening and capture the nuanced perspectives of stakeholders. Overall, 28 in-depth interviews were conducted with key participantsstakeholders, including PLHIV, health workers, community-based actors, and members of the national coordination teams.Home-based testing was identified as a key facilitator for to improving access to healthcare by reducing financial and logistical barriers. However, several obstaclesbarriers hindered its effectiveness, including frequent stock shortages, concerns about confidentiality and stigma, insufficientlack of training and incentives for community health workerscommunity counselors, and the absence of clear protocols that defining e the roles and responsibilities of stakeholders.The findings emphasize the need to strengthenimprove community-based HIV testing in Guinea by ensuring a consistent supply iesof essential resources, better stakeholder enhancing coordination among stakeholders, and providing adequate incentives for community counselorshealth workers. Integrating this approach into national policies could enhance both its effectiveness and sustainability, offering actionable insights for adapting HIV testing strategies in similar resource-limited settingscontexts..