Barriers and Facilitators of HIV Self-Testing in Africa: A Qualitative Systematic Review

Abstract

Background: HIV self-testing (HIVST) is an innovative approach that has the potential to improve HIV testing uptake and linkage to care for those who test positive. In this systematic review, we explored barriers and facilitators to HIVST uptake for various populations in Africa. Methodology: We systematically searched multiple electronic databases for relevant English-language articles published between January 2015 and February 2023. The databases included PubMed, Cumulative Index for Nursing and Allied Health Professions Literature (CINAHL), Embase, and Scopus for qualitative research articles on HIVST from different African countries. Findings: A total of 313 articles were identified through a literature search, and 11 met the inclusion criteria. This review shows that HIVST is a highly acceptable method of HIV testing among various populations. Perceived facilitators of the uptake of HIVST were convenience, autonomy and self-empowerment, privacy, confidentiality, and ease of use. The perceived barriers included the cost of self-test kits, perceived unreliability of test results, low literacy, fear and anxiety of a positive test result, potential psychological and social harms, and a lack of linkage to care. Conclusion: This review observes that the establishment of innovative approaches such as mobile phone counselling to support pre- and post-test care for those seeking HIVST is critical for the successful scaling up of this intervention. Furthermore, for resource-poor contexts, affordable HIVST is essential to ensure the absorption of the same.