Implementation of a campus-based and peer-delivered HIV self-testing intervention to improve the uptake of HIV testing services among university students in Zimbabwe: the SAYS initiative

Abstract

Background The uptake of HIV testing services among adolescents and young adults in Zimbabwe is low due to stigma associated with the risk of mental and social harm. The WHO recommends HIV self-testing (HIVST) as an innovative approach to improve access to HIV testing for this hard-to-reach populations. This study describes the development and implementation of a coordinated multifaceted and multidisciplinary campus-based approach to improve the uptake of HIV testing among university students in Zimbabwe. Methods We utilized both quantitative and qualitative methods guided by the Exploration, Preparation, Implementation, and Sustainment Framework. A formative survey, in-depth interviews, and a scoping review were conducted as part of the situation analysis. Implementers (peer educators and health workers) were trained and community dialogue sessions were conducted to ascertain the determinants (enablers and barriers) influencing both the inner and outer contexts. Self-test kits were disbursed over 6 months before a summative evaluation survey was conducted. Qualitative data were analyzed thematically while the chi-squared test was used to analyze quantitative data. Results The formative evaluation showed that 66% of students intended to test and 44% of the enrolled students collected HIVST test kits. Giving comprehensive and tailored information about the intervention was imperative to dispel the initial skepticism among students. Youth-friendly and language-specific packaging of program materials accommodated the students. Despite the high acceptability of the HIVST intervention, post-test services were poorly utilized due to the small and isolated nature of the university community. Implementers recommended that the students seek post-test services off-site to ensure that those with reactive results are linked to treatment and care. Conclusions Peer-delivered HIVST using trained personnel was acceptable among adolescents and young adults offered the intervention at a campus setting. HIVST could increase the uptake of HIV testing for this population given the stigma associated with facility-based HTS and the need for routine HIV testing for this age group who may not otherwise test. An off-site post-test counseling option is likely to improve the implementation of a campus-based HIVST and close the linkage to treatment and care gap.

Factors associated with HIV self-testing among female university students in Uganda: a cross-sectional study

“…Students at Makerere University received free access to self-test kits from the institution’s hospital, which could have influenced their desire to use HIVST. Leveraging on the high acceptability of self-test kits, delivery through trained peers at female student’s places of residence could increase HIVST uptake and demand for HIV testing services [ 13 ].…”

“…Only 80% of female students had ever been tested for HIV, significantly below UNAIDS 95–95-95 targets of 95% people knowing their HIV status [ 12 ]. It is likely that some students who had never been tested, such as the 47% who were sexually inexperienced did not see the necessity for HIV testing or had a low self-risk perception of HIV [ 13 ]. Notably, HIV testing among female university students was below the national average for AGYW (92% for older AGYW) in Uganda [ 8 ].…”

“…AGYW with a history of use of HIVST can be trained and leveraged as peers to mobilize colleagues to self-test, distribute kits, and support those eager to self-test for HIV [ 13 , 17 ]. Formative surveys can identify peers before implementing HIVST scale-up programs [ 13 ].…”

“…AGYW with a history of use of HIVST can be trained and leveraged as peers to mobilize colleagues to self-test, distribute kits, and support those eager to self-test for HIV [ 13 , 17 ]. Formative surveys can identify peers before implementing HIVST scale-up programs [ 13 ]. Identifying characteristics of AGYW willing to use HIVST also helps prioritize distribution of self-test kits among peers during HIVST expansion and scale-up programs.…”

“…HIVST increases testing uptake and is not associated with increased sexual risk behaviour among key populations [12]. The Swipe And Know Your Status (SAYS) HIVST initiative, for example, increased HIV testing services among university students in Zimbabwe from 6% in the previous year to 44% in just 6 months [13]. AGYW have exhibited high acceptability and demand for HIVST due to convenience, non-invasive approaches, and privacy, and ability to self-test and interpret their results accurately [13][14][15].…”