Female Sex Workers Often Incorrectly Interpret HIV Self-Test Results in Uganda

Ortblad, Katrina F; Musoke, Daniel Kibuuka; Ngabirano, Thomson; Nakitende, Aidah; Haberer, Jessica; McConnell, Margaret; Salomon, Joshua A.; Bärnighausen, Till; Oldenburg, Catherine E.

doi:10.1097/qai.0000000000001765

Cited by 34 publications

(38 citation statements)

References 40 publications

(40 reference statements)

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“…This review further revealed that the oral HIVST model is acceptable among men, supporting the findings of other studies conducted among other study populations in different settings [11,52]. Like other studies in different settings, this study also found similar concerns regarding the need for HIVST counselling [53,54], as well as the potential for incorrect interpretation of HIV self-testing results [55]. Notwithstanding the concerns that men raised, the findings support the theory that the HIVST model has the potential to increase the uptake of HIV testing, especially among men.…”

Section: Discussionsupporting

confidence: 87%

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

et al. 2020

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Background: Despite the many HIV testing models implemented in Africa, the level of HIV testing uptake remains relatively poor, especially among men. The HIV self-testing (HIVST) model offers an additional approach for encouraging men to get tested. This study aimed to synthesise evidence on men's perspectives regarding HIVST in sub-Saharan Africa (SSA). Methods: The databases searched included PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations; SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; ERIC; CINAH; PsychInfo; Embase, Sociological Abstract, Scopus; and Google Scholar. The World Health Organization (WHO) and The Joint United Nations' Programme on HIV and AIDS (UNAIDS) websites were further searched. We only extracted qualitative information from the included studies, despite the research method used (qualitative or mixed methods). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), as well as the Mixed Method Appraisal Tool (MMAT) version 2018, were used to determine the methodological quality of the included studies. NVivo version 11 was used for thematic analysis. Results: A total of 21,184 articles were identified by the initial search criteria, but only 16 articles were included in the data extraction and quality assessment stage. The following key themes emerged: knowledge of HIVST; acceptability of HIVST; need for HIVST counselling; confidentiality of HIVST; convenience of HIVST; and accuracy of HIVST. The study shows that while HIVST provides men with an alternative, confidential and convenient testing model, the potential for psychological and physical harm remains a challenge. Conclusion: The introduction of the HIVST strategy has the potential of improving men's uptake in HIV testing services, thereby contributing towards addressing the first cascade of the 90-90-90 strategy. While HIVST has a potential for addressing men's barriers to attending clinic settings, such as confidentiality and convenience, it barely addresses the HIVST counselling and accuracy concerns.

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Section: Discussionsupporting

confidence: 87%

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

et al. 2020

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“…Several reports evaluating supervised strategies among adults have documented the risk of errors in the interpretation of test results [31][32][33]. Among adolescents, the risk of error when completing a self-test was less frequent than when interpreting the test [31][32][33]. The misinterpretation of self-test results concerned mainly invalid tests, as previously reported by Ortblad and colleagues among female sex workers in Uganda [33].…”

Section: A Feasibility B Concordance Between Adolescents and Supervmentioning

confidence: 72%

“…However, this difficulty was overcome among study adolescents when verbal instructions was provided (42.2% of cases). Several reports evaluating supervised strategies among adults have documented the risk of errors in the interpretation of test results [31][32][33]. Among adolescents, the risk of error when completing a self-test was less frequent than when interpreting the test [31][32][33].…”

Section: A Feasibility B Concordance Between Adolescents and Supervmentioning

confidence: 99%

Acceptability, feasibility, and individual preferences of blood-based HIV self-testing in a population-based sample of adolescents in Kisangani, Democratic Republic of the Congo

et al. 2019

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Background Adolescents living in sub-Saharan Africa constitute a vulnerable population at significant risk of HIV infection. This study aims to evaluate the acceptability, feasibility, and accuracy of home-based, supervised HIV self-testing (HIVST) as well as their predictors among adolescents living in Kisangani, Democratic Republic of the Congo (DRC). Methods A cross-sectional, door-to-door survey using a blood-based HIV self-test and a peer-based supervised HIVST approach was conducted from July to August 2018 in Kisangani, DRC. The acceptability and feasibility of HIVST were assessed among adolescents' consenting to use and interpret HIV self-test. The accuracy of HIVST was estimated by the sensibility and specificity of adolescent-interpreted HIV self-test. Factors associated with acceptability and feasibility of HIVST were analyzed with logistic regression. Results A total of 628 adolescents (including 369 [58.8%] females) aged between 15 and 19 years were enrolled. Acceptability of HIVST was high (95.1%); 96.1% of participants correctly used the self-test, and 65.2% asked for verbal instructions. The majority of adolescents (93.5%) correctly interpreted their self-test results. The Cohen's κ coefficient between the results read by adolescents and by supervisors was 0.62. The correct interpretation decreased significantly when adolescents had no formal education or attended primary school as compared to those currently attending university (37.0% versus 100%; adjusted OR: 0.01 [95%

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“…Men who have sex with men in South Africa preferred fingerstick self-testing but were better able to perform the oral fluid tests resulting in the need for additional instructional resources for blood-based testing in this context [39]. Ortblad et al reported that when peer educators working with female sex workers in Uganda gave an HIVST demonstration based on materials developed without detailed knowledge of common misunderstandings, the sex workers struggled to correctly interpret the test results [40]. In Zimbabwe, on the other hand, where female sex workers were shown a video based on findings from cognitive interviews, they were able to correctly perform and interpret oral fluid-based HIVST [38].…”

Section: Discussionmentioning

confidence: 99%

Ability to understand and correctly follow HIV self‐test kit instructions for use: applying the cognitive interview technique in Malawi and Zambia

et al. 2019

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Introduction The ability to achieve an accurate test result and interpret it correctly is critical to the impact and effectiveness of HIV self‐testing (HIVST). Simple and easy‐to‐use devices, instructions for use (IFU) and other support tools have been shown to be key to good performance in sub‐Saharan Africa and may be highly contextual. The objective of this study was to explore the utility of cognitive interviewing in optimizing the local understanding of manufacturers’ IFUs to achieve an accurate HIVST result. Methods Functionally literate and antiretroviral therapy‐naive participants were purposefully selected between May 2016 and June 2017 to represent intended users of HIV self‐tests from urban and rural areas in Malawi and Zambia. Participants were asked to follow IFUs for HIVST. We then conducted cognitive interviews and observed participants while they attempted to complete the HIVST steps using a structured guide, which mirrored the steps in the IFU. Qualitative data were analysed using a thematic approach. Results Of a total of 61 participants, many successfully performed most steps in the IFU. Some had difficulties in understanding these and made errors, which could have led to incorrect test results, such as incorrect use of buffer and reading the results prematurely. Participants with lower levels of literacy and inexperience with standard pictorial images were more likely to struggle with IFUs. Difficulties tended to be more pronounced among those in rural settings. Ambiguous terms and translations in the IFU, unfamiliar images and symbols, and unclear order of the steps to be followed were most commonly linked to errors and lower comprehension among participants. Feedback was provided to the manufacturer on the findings, which resulted in further optimization of IFUs. Conclusions Cognitive interviewing identifies local difficulties in conducting HIVST from manufacturer‐translated IFUs. It is a useful and practical methodology to optimize IFUs and make them more understandable.

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Female Sex Workers Often Incorrectly Interpret HIV Self-Test Results in Uganda

Cited by 34 publications

References 40 publications

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

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

Acceptability, feasibility, and individual preferences of blood-based HIV self-testing in a population-based sample of adolescents in Kisangani, Democratic Republic of the Congo

Ability to understand and correctly follow HIV self‐test kit instructions for use: applying the cognitive interview technique in Malawi and Zambia

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