Acceptability and performance of a directly assisted oral HIV self-testing intervention in adolescents in rural Mozambique

Abstract

IntroductionWhereas progress in HIV testing and treatment has been made globally, the UNAIDS goal of “90 90 90” is still out of sight in rural northern Mozambique. New strategies that promote testing in hard to reach groups will aid Mozambique’s response to the HIV epidemic. HIV self-testing (HIVST) is recommended by the WHO as an additional approach to augment the HIV testing services available to adolescents. This study evaluates acceptability and performance of a directly assisted oral HIVST intervention for adolescents in rural Mozambique.MethodsAdolescents aged 16–20 years were included at schools and invited to attend the local hospital’s youth friendly service for directly assisted oral HIVST. Baseline and post-test questionnaires were obtained. OraQuick Rapid HIV-1/2 Anti body test® was used. Results were read by the participant and by a nurse. Results were confirmed by finger prick HIV test (Determine® HIV 1/2 Alere and Unigold™ HIV Trinity Biotech) according to the Mozambican national standard.ResultsBetween September and November 2016, 496 adolescents were included, of which 299 performed an oral HIV self-test. 70% were first time testers. The positivity rate was 1.7%. The inter-rater agreement between adolescent and nurse was 99.6% (kappa 0.93); there were no false negative or false positive results of the oral HIV self-test. Five tests were invalid. 7.1% found the test difficult to use. Over 80% preferred directly assisted HIVST compared to the standard finger prick testing. While 20% thought it would be good to do HIVST at home, 76% preferred to do HIVST at the health centre, for reasons including increased security, privacy, and the presence of a counsellor.ConclusionsDirectly assisted oral HIVST is a feasible intervention for adolescents in rural Mozambique and showed encouraging results for first time HIV testers.

Uptake of HIV self‐testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

“…In our observation of 16 participants as part of the formative assessment before the distribution of the kits, common errors include not collecting sample correctly, not putting the swab into the bottle correctly, and not waiting enough time (20 minutes) before reading the result [data not shown]. In this current study, we found a fairly high rate of indeterminate or invalid results or uncertainty of result (4.4%), which is higher than what has been reported when subjects performed supervised oral HST after a demonstration of the test kit usage in a rural community in rural Mozambique (5/496 = 1.7%) . However, one of the first HIVST validation studies conducted in Kenya in 2013 reported a higher rate of invalid HIV results (37/239 = 15.5%) .…”

“If it is left, it becomes easy for me to get tested”: Use of oral self‐tests and community health workers to maximize the potential of home‐based HIV testing among adolescents in Lesotho

“…Direct (i.e. primary) distribution of HIVST in sub‐Saharan Africa has shown to successfully reach high testing rates among AYA across various testing modalities [23‐26]. However, to our knowledge, ADORE is among the first studies exploring secondary distribution of HIVST during home‐based HIV testing in AYA.…”

Uptake and impact of facility‐based HIV self‐testing on PrEP delivery: a pilot study among young women in Kisumu, Kenya

“…Several studies in sub-Saharan Africa have shown high acceptability, uptake and accurate use of HIV self-testing (HIVST) in men and women in populations such as adolescents [5][6][7][8], female sex workers and their partners [9,10], and partners of women seeking antenatal and postnatal care [10,11]. Compared to provider-initiated testing and counselling, facility-based HIVST has been shown to be highly acceptable among adolescents aged 15 to 24 years [8].…”

“…In the context of using PrEP, HIVST has been shown to be highly acceptable by mutually disclosed serodiscordant couples [12] and female sex workers who are interested in PrEP [13]. Nevertheless, most studies of HIVST have only evaluated HIVST for screening [7,10,12,[14][15][16][17][18] and to date, no study has evaluated the integration of facility-based HIVST in PrEP delivery and its use as a tool to optimize patient flow and visit efficiency.…”