Usability assessment of seven HIV self-test devices conducted with lay-users in Johannesburg, South Africa

Abstract

IntroductionThe first 90 of the 90-90-90 initiative introduced by the World Health Organization(WHO) in 2015 requires 90% of people with HIV be aware of their status by 2020. In South Africa, conventional facility-based testing had reached 84.9% in 2018; innovative new methods, like HIV self-testing(HIVST) may close the testing gap. This study aimed to determine the usability of seven HIVST kits among untrained South Africans. MethodsThis cross-sectional study of 1400 adults in Johannesburg evaluated the usability of five blood fingerstick and two oral fluid HIVSTs, using WHO prequalification criteria, from June 2016 to June 2018. Participants were handed one kit, with no further information about the device or test procedure, and asked to perform the test in front of an observer. The observer used product-specific semi-structured questionnaires organized into a composite usability index(UI) using a HIVST process checklist, a contrived results interpretation and a post-test interview that expanded on participant experiences with the device and instructions-of-use (IFU). Participants were not tested themselves, but provided with contrived results to interpret. ResultsThe average UI was 92.8%(84.2%-97.6%); the major difficulty was obtaining and transferring the specimen. Participants correctly interpreted 96.1% of the non-reactive/negative, 97.0% of the reactive/positive, 98.0% of the invalid and 79.9% of the weak positive results. Almost all participants(97.0%) stated they would visit a clinic or seek treatment for positive results; with negative results, half(50.6%) stated they should re-test in the next three months while one-third(36.1%) said they should condomize. Nearly all found the devices easy to

Evaluation of a mobile application to support HIV self-testing in Johannesburg, South Africa

“…Errors stemming from the IFUs have been well documented in a number of HIVST studies, including ones from South Africa. 38 , 39 , 40 Suggestions like clarifying the instructions, incorporating video or voice notes, and offering additional languages should all be taken into consideration, especially as more HIVSTs, each with specific IFUs, become available to the market. Some of these suggestions have already been implemented by other platforms, as the HIVSmart TM app is already available in both of Canada’s national languages, and provides supplemental video content.…”

Usability and Acceptability of Home-based Self-testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibodies for Population Surveillance

“…Metrics to evaluate usability and acceptability were based on the HIV self-testing literature (5,6,8) and were measured as the percentage of participants responding to specific closed questions in the online survey. The questionnaire used is available as an online supplement (Supplement, S2).…”

“…There are many advantages in terms of uptake, cost, patient activation and scale (4,6), but also potential disadvantages in relation to validity, usability and practicality which should be explored (6,7). Usability research on HIV selftesting has generally found good acceptability, the devices easy to use and high validity in interpretation of self-reported test results (7)(8)(9). However, these HIV test kits were designed for selfsampling and self-testing and went through several iterations before designs were appropriate for home use and therefore the same levels of acceptability and usability for home-based self-testing for SARS-CoV-2 antibody using LFIAs cannot be assumed.…”

Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe

“…An exit interview guide was developed to qualitatively assess specific facilitators and barriers for syphilis self-testing. Participants also completed a survey to establish quantitative usability of the test, adapted from a HIVST usability index used in South Africa (20). Qualitative data was analysed following the Rapid Assessment Procedures (RAP), a set of methodologies designed for rapid assessment of health-seeking behaviour (21).…”