“I think it is right”: a qualitative exploration of the acceptability and desired future use of oral swab and finger-prick HIV self-tests by lay users in KwaZulu-Natal, South Africa

Abstract

BackgroundThe uptake of HIV testing has increased in sub-Saharan Africa over the past three decades. However, the proportion of people aware of their HIV status remains lower than required to change the pandemic. HIV self-testing (HIVST) may meet this gap. Assessment of readiness for and the acceptability of HIVST by lay users in South Africa is limited. This paper presents results from a formative study designed to assess the perceived usability and acceptability of HIVST among lay users using several self-test prototypes. Fifty lay users were purposively selected from rural and peri-urban KwaZulu-Natal, South Africa. Acceptability of HIVST was assessed using a simple post-test quantitative assessment tool addressing confidence, ease-of-use, intended future use and willingness to pay. In-depth qualitative interviews explored what participants felt about the HIVST and why, their willingness to recommend and how much they would pay for a test.ResultsThe key finding is that there is high acceptability regardless of self-test prototype. Acceptability is framed by two domains: usability and perceived need. Perceived usability was explored through perceived ease of use, which, regardless of actual correct usage, was reported by many of the respondents. Acceptability is influenced by perceived need, expressed by many who felt that the need for the self-test to protect privacy and autonomy. Ease of access and widespread availability of the test, not at a significant cost, were also important factors. Many participants would recommend self-test use to others and also indicated that they would choose to conduct the test again if it was free while some also indicated being willing to buy a test.ConclusionsThe positive response and readiness amongst lay users for an HIVST in this context prototype suggests that there would be a ready and willing market for HIVST. For scalability and sustainability usability, including access and availability that are here independent indications of acceptability, should be considered. So too should the desire for future use, as an additional factor pointing to acceptability. The results show high acceptability in all of these areas domains and a general interest in HIVST amongst lay users in a community in KwaZulu-Natal.

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

“…As a result of the research method used (qualitative or mixed methods), qualitative data from the sixteen included studies were extracted. The included studies were conducted in the following countries: Zambia [24], Malawi [11,25], South Africa [12,[26][27][28][29][30], Tanzania [31][32][33], Uganda [34,35], Zimbabwe and Malawi [36], and Kenya [37]. Twelve studies were predominantly qualitative and four were mixed methods.…”

“…The evidence on acceptability was reported on in nine studies [11,12,25,26,[31][32][33][34]37]. The majority of men showed a willingness to use HIVST in studies conducted in Malawi [11], Tanzania [32,33], South Africa [26], and Kenya [37], with most of the participants having administered HIVST in the past in Tanzania [33]. The oral HIVST was preferred over finger-pricking [26], although respondents agreed that HIVST, in general, was easy to use [26,37].…”

“…Well, initially I was a bit nervous because I was just starting. But now I'm getting more comfortable because I've seen how it works" [ [26], p. 4].…”

“…Some men further indicated that they would recommend HIVST to friends and family members [11]. Others thought that their friends who generally resisted HIV testing would be encouraged to try the HIVST model [31], especially because this HIV testing model could be perceived as addressing the barriers associated with the clinic-based HIV testing model [25], as expressed by one male participant in South Africa: "I would rather not go to the clinic once I know how to use it I can then test myself" [ [26], p. 4]. Also, using women who attend ANC clinics to deliver HIVST to their male partners has been seen to be acceptable by men in Uganda and Malawi, and it is perceived to improve partner and couples' HIV testing [25,34].…”

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

“…The current data around HIVST is growing, but still inadequate from sub-Saharan African countries when considering the burden and distribution of HIV, and research regarding appropriate counselling services and implementation of HIVST is needed [14]. In addition, previous qualitative research suggests further exploration of counselling provision during HIVST is necessary, specifically within South Africa [15]. Currently, testers only have the option to choose between the privacy of HIVST with limited counselling and support, or seeking the option of face-to-face counselling provided in conventional clinic-based testing that comes with concerns of privacy and stigmatization.…”