Improving HIV disclosure to sexual partners via assisted partner notification services: A mixed-method study on utilization, barriers, and facilitators

BackgroundThe global burden of HIV remains substantial, with Tanzania among the most affected countries in sub-Saharan Africa. The central regions of Tanzania such as Singida region, has high new HIV infections, partly driven by low voluntary HIV disclosure among couples. Assisted Partner Notification Services (APNS) have emerged as a promising strategy to support HIV disclosure, promote partner testing, and reduce transmission. Despite this potential, APNS remains underutilized due to a range of individual, social, and structural barriers. ObjectivesThis study aimed to assess the utilization of APNS and identify barriers and facilitators influencing its uptake among people living with HIV (PLWH) in Singida, Tanzania. MethodsWe employed a convergent mixed-methods design. A cross-sectional survey quantified APNS utilization and associated factors among PLWH with sexual partners, while qualitative interviews explored barriers and facilitators from the perspectives of both PLWH and healthcare providers (HCPs). ResultsOnly 40% of participants reported APNS utilization. Higher knowledge of HIV disclosure was positively associated with uptake (AOR = 2.65, 95% CI: 2.28-2.81; p = 0.02), whereas depressive symptoms reduced engagement (AOR = 0.95, 95% CI: 0.91- 0.99; p = 0.027). Awareness of pre-exposure prophylaxis (PrEP) was strikingly low (13%). Reported barriers included stigma, fear of financial and emotional insecurity, cultural constraints, and weak health system support. Facilitators involved emotional readiness, trust in providers, mobile outreach, and supportive community structures. Participants recommended enhanced APNS education, mental health integration, strengthened provider training, and improved access through transport and outreach interventions. ConclusionFindings reveal low APNS uptake in Singida, constrained by stigma, mental health challenges, and systemic gaps. Strengthening disclosure knowledge, provider trust, and outreach services, while integrating APNS with PrEP and chronic disease care, may enhance impact and reduce HIV transmission.