HIV Self-Testing Could “Revolutionize Testing in South Africa, but It Has Got to Be Done Properly”: Perceptions of Key Stakeholders

Abstract

South Africa bears the world’s largest burden of HIV with over 6.4 million people living with the virus. The South African government’s response to HIV has yielded remarkable results in recent years; over 13 million South Africans tested in a 2012 campaign and over 2 million people are on antiretroviral treatment. However, with an HIV & AIDS and STI National Strategic Plan aiming to get 80 percent of the population to know their HIV status by 2016, activists and public health policy makers argue that non-invasive HIV self-testing should be incorporated into the country HIV Counseling and Testing [HCT] portfolios. In-depth qualitative interviews (N = 12) with key stakeholders were conducted from June to July 2013 in South Africa. These included two government officials, four non-governmental stakeholders, two donors, three academic researchers, and one international stakeholder. All stakeholders were involved in HIV prevention and treatment and influenced HCT policy and research in South Africa and beyond. The interviews explored: interest in HIV self-testing; potential distribution channels for HIV self-tests to target groups; perception of requirements for diagnostic technologies that would be most amenable to HIV self-testing and opinions on barriers and opportunities for HIV-linkage to care after receiving positive test results. While there is currently no HIV self-testing policy in South Africa, and several barriers exist, participants in the study expressed enthusiasm and willingness for scale-up and urgent need for further research, planning, establishment of HIV Self-testing policy and programming to complement existing facility-based and community-based HIV testing systems. Introduction of HIV self-testing could have far-reaching positive effects on holistic HIV testing uptake, giving people autonomy to decide which approach they want to use for HIV testing, early diagnosis, treatment and care for HIV particularly among hard-to reach groups, including men.

‘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

“…These consequences included fears of marital disruption and suicidal ideation [17] due to the absence of pre- or post-test counseling. Similar fears have been documented in other studies [18,19] especially with regard to fears of what could happen in the home in the event that one of the partners is HIV-positive, in the absence of post-test counseling. To deal with these fears, we provided adequate preparation to improve the women’s technical competencies and negotiation efficacy to improve their ability to deliver the kits as well as encourage their partners to test alone or together with them.…”

Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa

“…Most of our study samples are women, which is not surprising since we conducted a home-based HTC program during the day when men are more likely to be out of the home than women. The high proportion of women in our study is a reminder of a continuing need to address the gender gap by reaching more men for HIV testing (Sharma et al 2017) and to evaluate potential innovative outreach strategies, such as HIV self-testing kits (Makusha et al 2015). …”

Alone But Supported: A Qualitative Study of an HIV Self-testing App in an Observational Cohort Study in South Africa

“…HIVST is a process in which a person, often in private, collects his or her own specimen (oral fluid or blood) and performs and interprets their test [6]. HIVST has been demonstrated to positively impact HIV test uptake and frequency [7] and could lead to early diagnosis and treatment [8] while overcoming confidentiality concerns [5,9,10]. Clinic staff and HIV counselors in South Africa have to perform a high number of tests each day [11].…”

“…Yet, concerns have been raised regarding the lack of counselling and support during and after the self-testing process [8]. Research has shown that some participants struggle to complete oral self-testing on their own due to unclear instructions [12].…”