Acceptability of a Community-Based Outreach HIV-Testing Intervention Using Oral Fluid Collection Devices and Web-Based HIV Test Result Collection Among Sub-Saharan African Migrants: A Mixed-Method Study

Abstract

BackgroundLate human immunodeficiency virus (HIV) diagnosis is common among sub-Saharan African migrants. To address their barriers to HIV testing uptake and improve timely HIV diagnoses and linkage to care, the outreach HIV testing intervention, “swab2know,” was developed. It combined a community-based approach with innovative testing methods: oral fluid self-sampling and the choice between Web-based HIV test result collections using a secured website or post-test counseling at a sexual health clinic. The sessions included an informational speech delivered by a physician of sub-Saharan African origin and testimonies by community members living with HIV.ObjectivesThe objectives of this study were to evaluate the intervention’s acceptability among sub-Saharan African migrants and its potential to reach subgroups at higher risk for HIV infection and to identify facilitators and barriers for HIV testing uptake.MethodsThis mixed-method study combined qualitative (participant observations and informal interviews with testers and nontesters) and quantitative data (paper–pencil survey, laboratory data, and result collection files). Data were analyzed using a content analytical approach for qualitative and univariate analysis for quantitative data.ResultsA total of 10 testing sessions were organized in sub-Saharan African migrant community venues in the city of Antwerp, Belgium, between December 2012 and June 2013. Overall, 18.2% of all people present (N=780) underwent HIV testing; 29.8% of them tested for HIV for the first time, 22.3% did not have a general practitioner, and 21.5% reported 2 or more sexual partners (last 3 months). Overall, 56.3% of participants chose to collect their HIV test results via the protected website. In total, 78.9% collected their results. The qualitative analysis of 137 participant observation field notes showed that personal needs and Internet literacy determined the choice of result collection method. Generally, the oral fluid collection devices were well accepted mainly because sub-Saharan African migrants dislike blood taking. For some participants, the method raised concerns about HIV transmission via saliva. The combination of information sessions, testimonies, and oral fluid collection devices was perceived as effectively reducing thresholds to participation. Acceptability of the intervention differed between individual participants and settings. Acceptance was higher among women, in churches and settings where community leaders were engaged in HIV awareness raising. Higher preventive outcomes were observed in settings with lower acceptance. The presence of the intervention team visualized the magnitude of the HIV epidemic to the public and promoted HIV testing uptake at large, for example, those who declined indicated they would take up testing later.ConclusionsWhen accompanied by tailored provision of information, outreach HIV testing interventions adopting a community-based approach and innovative methods such as Web-based result collection and oral fluid collection devices are ac...

Reaching the First 90: Proposal for Intervention Strategy in Order to Expanding Access to HIV Testing among Migrant and Vulnerable Populations

“…One strategy could be the use of HIV rapid test inside the health care services and prevention programs. In fact we observed a high acceptability of HIV rapid test, as another study described [30]. For this reason, we propose also the availability of rapid HIV testing at the moment of delivery or for example, in Emergency Departments in presence of "indicators diseases.…”

HIV testing within the African community using home‐based self collection of oral samples

“…The proficiency of English for many of the clients had been of a low level, such that delivery of a result in English was difficult and, despite the option for a professional interpreter to be freely available, only eight participants used this service. Interestingly, our proportion of participants who could not be contacted for results was comparable to a similar study in Belgium that relied on both a web‐based and clinic‐based system of reporting 4 . Our high proportion of clientele who could not be contacted for results, the difficulties encountered in returning results to others and the relatively high number of invalid results does raise questions about the efficacy of this strategy.…”

“…Interestingly, our proportion of participants who could not be contacted for results was comparable to a similar study in Belgium that relied on both a web-based and clinic-based system of reporting. 4 Our high proportion of clientele who could not be contacted for results, the difficulties encountered in returning results to others and the relatively high number of invalid results does raise questions about the efficacy of this strategy. As with our previous pilot of mailed, self-collected oral specimens, 3 the limitations identified by our African community HIV testing trial strengthen the case for self-testing or other forms of point-ofcare testing within home or other culturally safe settings.…”

HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance

“…Twenty studies provided non‐targeted testing to the general population, while 44 studies provided testing to one or more groups at higher risk of HIV infection. MSM were the group most frequently targeted ( n = 31) , followed by: migrants ( n = 10) , people who use/inject drugs (PWUD/PWID) ( n = 8) , SWs ( n = 7) , black and minority ethnic groups (BME) ( n = 5) , young people ( n = 4) , homeless people ( n = 3) , and other key risk populations not specified ( n = 3) .…”