Acceptability of index partner HIV self-testing among HIV-positive clients in Malawi: A mixed methods analysis

Abstract

We sought to evaluate whether HIV-positive adults in Malawi were willing to distribute HIV self-testing (HIVST) kits to their sexual partners of unknown HIV status (index HIVST). Design A mixed-methods study was nested within a larger HIVST trial conducted at 15 health facilities in Malawi. Exit surveys were conducted with HIV-positive adults during routine outpatient department visits to assess perceived acceptability of index partner HIVST versus standard partner referral slips that request partner(s) to attend the health facility. Individuals were included in the sub-analysis irrespective of date of HIV diagnosis or ART initiation (or non-initiation). In-depth interviews were conducted with a sub-sample of respondents. Results 404 HIV-positive adults completed a survey (159 male and 245 female); 21 completed indepth interviews. Respondents reported feeling more comfortable distributing HIVST versus partner referral slips to their partners (90% vs. 81%) and expressed confidence that their partners would test using HIVST compared to referral slips (77% vs. 66%). Acceptability of HIVST did not vary by sex. Qualitative data revealed that index HIVST was perceived to be private, convenient, and may strengthen relationships by assisting in serostatus disclosure. There were minimal fears of adverse events. Reported barriers to index HIVST included lack of trust within the relationship and harmful gender norms. Conclusions HIV-positive clients were willing to distribute HIVST kits to their sexual partners of unknown serostatus. Additional studies are needed to evaluate use of HIVST by index partners,

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

“…Nearly all studies concluded that HIV-ST was perceived easy to use [23, 28, 30-32, 35, 38, 40, 42, 44, 46, 47, 49, 57, 61, 63, 68, 70, 74, 77, 80, 82, 83, 85, 127, 130-134, 141]. Most studies 107,113,114,119,121,[183][184][185][186][187][188][189][190] and six observational mixed method studies [126,129,136,138,191,192]. While adoption is distinct from appropriateness, we found that qualitative results for adoption overlapped with results for appropriateness and we opted to report them together (with acceptability) in the next section.…”

“…Proper kit design for the target population was often mentioned. Design considerations included the instructional materials [90, 98, 100, 103, 107, 114, 120, 124, 131-133, 187, 190, 201-203] and the type of fluid (blood or oral fluid) [90,92,100,102,104,106,108,110,114,116,119,124,127,131,132,137,139,184,191,196]. Instructions needed to be clear and easy to understand.…”

“…Studies seem to agree that to mitigate these risks (e.g., negotiation skills training) must be included in the HIV-ST program if partner distribution is adopted as a strategy. A few papers [114,183,184,186,191] outlined strategies used by female distributors on how to engage their partners. Examples are: (1) selecting the appropriate time and place for introducing self-or couple testing, (2) developing a distraction free environment for the discussion and testing, (3) mentioning positive experiences and/or benefits of HIV-ST, and (4) reassuring partners that it is a couple's activity and not meant to test their commitment.…”

Implementation of Unassisted and Community-Based HIV Self-Testing (HIVST) during the COVID-19 pandemic among Men-who-have-sex-with-Men (MSM) and Transgender Women (TGW): A Demonstration Study in Metro Manila, Philippines

“…For implementers, the design of our demonstration study can be patterned to future programs on HIVST that are tailored to other local MSM and TGW communities in the Philippines. HIVST is said to increase HIV testing [47, 55, 56] among key populations; thus, implementers should include HIVST as one of the key indicators in their existing HIV Testing and Counselling Services (HTS). Lastly, funding agencies or companies may consider HIVST their Corporate Social Responsibility (CSR) service by helping the community as potential sustainable funding sources [57].…”

HIV self-testing: lessons learnt and priorities for adaptation in a shifting landscape

“…3 4 Safety, a major concern from the outset, was demonstrated through extensive social science research, confirming minimal social and physical harms. [5][6][7] Outcomes of HIVST research have also focused on 'real-world' implementation and relevance to policymakers, with randomised trials assessing linkage to HIV treatment, HIV prevention services for those who test HIV-negative and cost-effectiveness. 8 Research on how populations want HIVST delivered, coupled with lessons learnt from implementation and evaluation, has informed scale-up in many high burden settings.…”