Acceptability of HIV self-testing among men and women in KwaZulu-Natal, South Africa

Abstract

Successful implementation of Universal Test and Treat as a strategy to achieve the 90-90-90 target requires higher HIV testing rates. Currently, uptake of HIV testing is not optimal which has directed research initiatives towards identification of additional HIV testing methods. HIV self-testing (HIVST) has received growing attention as a complementary testing approach as it overcomes barriers that are commonly associated with current HIV testing methods. In sub-Saharan Africa, acceptability rates showed a gendered pattern of men benefitting more than women, with limited evidence to explain this difference. This study assessed whether men or women in KwaZulu-Natal displayed a higher acceptance of HIVST and also explored factors that influenced and motivated their acceptability. Participants were recruited through purposive sampling at two clinical research sites to participate and underwent qualitative assessments. The outcomes from focus group discussions coupled with findings from a scoping review informed the design and data collection instruments for in-depth interviews. A randomised cross-over study design exposed participants to HIV counselling and testing and HIVST, accompanied by before (baseline) and after in-depth interviews. HIVST was acceptable among most participants with acceptability higher in women. Men preferred HIVST due to convenience and efficiency, whilst women favoured HIVST due to its potential to provide autonomy and empowerment. Also, lack of HIV counselling and managing a positive HIV result as well as linkage to care were raised as deterrents of HIVST. As HIVST was acceptable by most participants, future research efforts should be directed towards evaluating the feasibility of its introduction into the public health sector.

Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis

“…As a result of the research method used (qualitative or mixed methods), qualitative data from the sixteen included studies were extracted. The included studies were conducted in the following countries: Zambia [24], Malawi [11,25], South Africa [12,[26][27][28][29][30], Tanzania [31][32][33], Uganda [34,35], Zimbabwe and Malawi [36], and Kenya [37]. Twelve studies were predominantly qualitative and four were mixed methods.…”

“…However, these strategies become ineffective in highly mobile communities [10]. HIV selftesting (HIVST) offers a new approach to improving men's HIV testing rates and removing some of the barriers associated with accessing clinic-based HIV testing services by enabling individuals to conduct and interpret their own HIV tests at their own convenient time and in a private space [11][12][13], whereas HIV self-sampling occurs when individuals collect their own samples (usually blood) and send their specimen to a laboratory for analysis [14]. HIVST can be administered orally (using saliva) or through finger-pricking (drawing of blood).…”

“…Some of the notable arguments against HIVST involve its high costs, insufficient counselling, and missed opportunities for STI screening [15]. Despite these arguments, HIVST has been shown to be widely acceptable in SSA [11,12,16], as well as among key population groups [13]. However, this acceptability has not seemed to have translated into an increase in the uptake of HIVST, especially among men in SSA.…”

“…Furthermore, the research evidence regarding men's perspectives towards HIVST, globally and SSA in particular, remains limited [12]. While more studies are being conducted to develop understanding of HIVST and innovative methods towards hard-to-reach populations globally, similar studies are also necessary for SSA [12]. In SSA, the limited literature on HIVST may be due to the fact that the adoption of HIVST is a recent development.…”

The Call to Get More Men Tested for HIV: A Perspective on What Policy Makers Need to Know for Implementing and Scaling up HIV Self-Testing in Rwanda

“…While HIVST has been confirmed to be a key strategy that can improve the uptake of HIV testing among men (Conway et al, 2015;Harichund, Moshabela, Kunene, & Abdool Karim, 2019;Hatzold et al, 2019), it also encounters different challenges, which have generally prevented its wide adoption. The findings of a scoping review by Harichund et al noted that, despite the implementation of numerous HIV testing models within sub-Saharan Africa (SSA) that aim to improve access to HIV testing, the uptake has generally remained very poor (Harichund et al, 2019).…”