‘I will welcome this one 101%, I will so embrace it’: a qualitative exploration of the feasibility and acceptability of HIV self-testing among men who have sex with men (MSM) in Lagos, Nigeria

Abstract

Men who have sex with men (MSM) are disproportionately affected by HIV in Nigeria. A key strategy in reducing transmission is to increase HIV testing uptake and linkage to treatment for those who test positive. HIV self-testing (HIVST) is an innovative strategy with the potential to increase uptake of HIV testing among key populations at higher risk for HIV. We conducted 23 in-depth-interviews with MSM and two focus group discussions with key opinion leaders to explore perceptions about the feasibility and acceptability of oral HIVST among MSM in Lagos, Nigeria. HIVST was highly acceptable because it was considered convenient to use, painless, private and addressed concerns about stigma. Concerns cited by participants included comprehensibility of instructions to perform and interpret results correctly, as well as lack of support mechanisms to facilitate post-test follow-up and linkage to care. Provision of adequate pre-test information was considered vital as part of the kit distribution process to ensure seamless use of HIVST kits. One-on-one peer-to-peer distribution strategies and retail outlets that facilitate anonymous pick-up are potential distribution channels identified in this study. Overall, our findings suggest that an HIVST program that incorporates these considerations would improve access to HIV testing among MSM in Nigeria.

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

“…Selecting the appropriate mode of kit distribution was important to ensure accessibility and adoption [57,78,90,92,99,104,105,108,110,112,119,122,137,139,141,163,184,189,190,202,204]. Modes of distribution described include: (1) direct delivery by community health workers, peers, partners, and sex workers, (2) Home delivery, and (3) Pick up at health facilities or community-based organizations or other sites (e.g., health clubs, markets, private pharmacies, vending machines).…”

“…Other reported considerations when designing HIV-ST programs included (1) adequate follow-up [100,113,118,120,127,135], (2) establishment of peer support networks [78, 104,107,122,140,199] and, (3) proper education on HIV-ST use [93, 98-100, 102, 106, 108-110, 112, 116, 120, 122, 127, 131, 133, 139, 140, 190, 196, 201, 206]. Education, both at the individual and community level, ensures proper technique and addresses any concerns on test accuracy.…”

“…Education to modify perceptions on HIV testing in general would then be needed. Education may also address potential problems like improper waste disposal [99,119,132,190,202], safety concerns (e.g., use of lancet as a weapon) [99,137], psychological results of inaccurate tests [93,190], sexual disinhibition due to negative results [100], and misconceptions regarding HIV or HIV-ST [90, 107,110,114,116,122,132] (e.g., How can they trust oral testing if HIV cannot be transmitted via saliva? ).…”

Operationalizing the distribution of oral HIV self-testing kits to men who have sex with men (MSM) in a highly homophobic environment: The Nigerian experience

“…Details of the study and its main ndings can be found elsewhere. [21,22] In this study, focus group discussions with the KOLs who distributed the HIVST kits and semi-structured in-depth interviews (IDIs) with MSM who received the kits were conducted three months after the kits were distributed.…”

“…This project was the rst implementation science research project to examine a distribution modality for HIVST kits among MSM in Nigeria. [22] In this paper, we describe the operationalization of this strategy based on qualitative interviews with KOLs and MSM who participated in this study.…”