HIV self-testing as part of a differentiated HIV testing approach: exploring urban and rural adult experiences from KwaZulu-Natal, South Africa using a cross-over study design

Abstract

BackgroundSuboptimal HIV testing rates through available testing approaches such as HIV counselling and testing have directed research efforts toward recognizing the potential of HIV self-testing as an additional testing method. However, HIV self-testing is not readily available within HIV testing facilities and data on how HIV self-testing and HIV counselling and testing will co-exist within HIV testing facilities is limited. Therefore, this study sought to fill this knowledge gap.MethodsForty consenting adults were exposed to HIV counselling and testing and HIV self-testing using a cross-over study design between February 2016 and February 2017 resulting in 80 (20,20) interviews. Participants were randomly exposed to HIV counselling and testing first, followed by self-testing, or HIV self-testing first, followed by counselling and testing. In-depth interviews were conducted at baseline, and after each testing exposure, using a semi-structured interview guide. Interviews were transcribed and translated prior to doing the framework analysis.ResultsSupport through counselling played a central role in the HIV testing process for some participants who desired support or were not confident to perform unsupervised HIV self-testing. The complementary relationship between HIV self-testing and HIV counselling and testing requires a combination of benefits such as availability of counselling, confidence, convenience and confidentiality (4 Cs) derived from HIV self-testing and HIV counselling and testing. Implementation of the 4 Cs will depend on the availability of unsupervised HIV self-testing and/or supervised self-testing with support from HIV counselling and testing.ConclusionsAs treatment and prevention efforts expand, the reasons for and frequency of testing is changing and there is a need to develop differentiated models for providing HIV testing services to meet client’s needs. HIV self-testing is an important addition to enhance HIV testing efforts and should be offered in combination with HCT.

Drivers and barriers to workplace-based HIV self-testing among high-risk men in Uganda: a qualitative study

“…Nonetheless, the men felt that HIV self-testing afforded them privacy while testing and the confidentiality of their results especially from their employers and peers. Studies have shown that men prefer HIV self-testing because it offers more privacy and confidentiality [ 30 , 31 ]. The men in the study also proposed the introduction of wellness days to incorporate several other health assessments to reduce stigma and improve the uptake of workplace-based HIV self-testing [ 32 , 33 ].…”

“…However, in Tanzania, men regarded the benefits of HIV self-testing over costs as savings made on the money paid to test in facilities and private clinics and on follow-up fees and time saved in other income generating activities [ 38 ]. This makes HIV self-testing convenient [ 31 ]. The men in this study proposed that the cost of the kits should be reduced or that they should be provided freely like other HIV testing modalities.…”

Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-analysis

“…One study showed that testing outside of clinics allowed for testing during the evenings, weekends, or holidays [ 44 ]. These approaches also allowed testers to test at home, at work, or at another location of their own choosing (3 studies in 3 countries) [ 26 , 35 , 45 ]. Testing outside of clinics allowed testers to give test kits to friends (1 study in 1 country) [ 22 ] and refer a partner (spouses and/or sex partners; 7 studies in 4 countries) [ 21 , 24 , 30 , 46–48 ].…”

Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-Analysis

“…One study showed that testing outside of clinics allowed for testing during the evenings, weekends, or holidays [44]. These approaches also allowed testers to test at home, at work, or at another location of their own choosing (3 studies in 3 countries) [26,35,45]. Testing outside of clinics allowed testers to give test kits to friends (1 study in 1 country) [22] and refer a partner (spouses and/or sex partners; 7 studies in 4 countries) [21,24,30,[46][47][48].…”