Acceptability of woman‐delivered HIV self‐testing to the male partner, and additional interventions: a qualitative study of antenatal care participants in Malawi

Abstract

Introduction: In the era of ambitious HIV targets, novel HIV testing models are required for hard-to-reach groups such as men, who remain underserved by existing services. Pregnancy presents a unique opportunity for partners to test for HIV, as many pregnant women will attend antenatal care (ANC). We describe the views of pregnant women and their male partners on HIV self-test kits that are woman-delivered, alone or with an additional intervention.Methods: A formative qualitative study to inform the design of a multi-arm multi-stage cluster-randomized trial, comprised of six focus group discussions and 20 in-depth interviews, was conducted. ANC attendees were purposively sampled on the day of initial clinic visit, while men were recruited after obtaining their contact information from their female partners. Data were analysed using content analysis, and our interpretation is hypothetical as participants were not offered self-test kits.Results: Providing HIV self-test kits to pregnant women to deliver to their male partners was highly acceptable to both women and men. Men preferred this approach compared with standard facility-based testing, as self-testing fits into their lifestyles which were characterized by extreme day-to-day economic pressures, including the need to raise money for food for their household daily. Men and women emphasized the need for careful communication before and after collection of the self-test kits in order to minimize the potential for intimate partner violence although physical violence was perceived as less likely to occur. Most men stated a preference to first self-test alone, followed by testing as a couple. Regarding interventions for optimizing linkage following self-testing, both men and women felt that a fixed financial incentive of approximately USD$2 would increase linkage. However, there were concerns that financial incentives of greater value may lead to multiple pregnancies and lack of child spacing. In this low-income setting, a lottery incentive was considered overly disappointing for those who receive nothing. Phone call reminders were preferred to short messaging service.Conclusions: Woman-delivered HIV self-testing through ANC was acceptable to pregnant women and their male partners. Feedback on additional linkage enablers will be used to alter pre-planned trial arms.

The Self‐Testing AfRica (STAR) Initiative: accelerating global access and scale‐up of HIV self‐testing

“…The agenda, which was in part funded by other partners, included formative research and accuracy studies to establish that HIVST was acceptable, safe, and could be correctly performed by priority populations . Further studies tested user preferences and established simple distribution models aimed at using HIVST for maximum public health impact . Data from these early distribution models informed costing and cost‐effectiveness studies to establish the evidence for HIVST scalability and sustainability .…”

Exploring social harms during distribution of HIV self‐testing kits using mixed‐methods approaches in Malawi

“…HIV self‐testing (HIVST) can increase HIV testing coverage and frequency . Several studies in Malawi have shown HIVST to be highly acceptable and able to reach first‐time testers, young people (aged 16 to 25), men and couples and partners , with acceptable linkage into facility‐based services when combined with facilitated linkage strategies . As with any form of HIV testing, however, potential social harms (SHs) must be anticipated and mitigated .…”

‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

“…A growing body of literature on oral HIV self-testing (HIVST) suggests that it can help to reach people that were not previously targeted by conventional HIV-testing approaches, including male partners and couples [1–3]. A recent systematic review and meta-analysis that examined the effects of HIVST compared with standard HIV-testing services found that HIVST not only doubled uptake of testing among men but also improved HIV-testing frequency particularly among men who have sex with men [4].…”

“…A recent systematic review and meta-analysis that examined the effects of HIVST compared with standard HIV-testing services found that HIVST not only doubled uptake of testing among men but also improved HIV-testing frequency particularly among men who have sex with men [4]. Studies conducted in Kenya [2,3,5] and Malawi [1,6] suggest that distribution of HIVST kits to male partners through female partners is an acceptable approach that provides an opportunity for men to test for HIV without necessarily traveling to a health facility. This may overcome the barriers related to lack of time or traveling to a health facility (which men presume to be a women’s preserve) to test for HIV [7,8].…”