Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study

Abstract

An estimated one in four transgender women (trans women) in the U.S. are infected with HIV. Rates of HIV testing are not commensurate with their risk, necessitating alternative strategies for early detection and care. We explored the feasibility and acceptability of HIV self-testing (HIVST) with 50 HIV-negative adult trans women in San Francisco. Participants received three self-test kits to perform once a month. Acceptability and behavioral surveys were collected as were 11 in-depth interviews (IDIs). Among 50 participants, 44 reported utilizing HIVST at least once; 94 % reported the test easy to use; 93 % said results were easy to read; and 91 % would recommend it to others. Most participants (68 %) preferred HIVST to clinic-based testing, although price was a key barrier to uptake. IDIs revealed a tension between desires for privacy versus support found at testing sites. HIVST for trans women was acceptable and feasible and requires careful consideration of linkage to support services.

Feasibility of supervised self‐testing using an oral fluid‐based HIV rapid testing method: a cross‐sectional, mixed method study among pregnant women in rural India

“…Factors contributing to the test's high acceptability include the ease of conducting the test, the short time to results and the non-invasive sample collection. These factors are similar to those reported as promoting acceptance in other studies, including convenience, ease of use, time-efficiency and the procedure being painless [41–43]. A cultural preference for giving an oral fluid rather than a blood sample was identified in a previous study in India, although the “novelty” of the oral fluid-based OraQuick ® test was reported as a possible reason for the preference [18].…”

“…A cultural preference for giving an oral fluid rather than a blood sample was identified in a previous study in India, although the “novelty” of the oral fluid-based OraQuick ® test was reported as a possible reason for the preference [18]. Unlike other studies [15,33,41] participants in our study did not report privacy as a significant motivator for self-testing, which may be related to a desire for social support that outweighs privacy as demonstrated in other self-testing studies [43]. …”

Latent class analysis of acceptability and willingness to pay for self‐HIV testing in a United States urban neighbourhood with high rates of HIV infection

“…This study adds empirical evidence to recent discussions about uptake and acceptability of HIVST among individuals at high risk for contracting HIV or in communities and neighbourhoods with high rates of infection [23–25]. In 2013, Philadelphia had nearly 700 new HIV diagnoses, adding to the total of nearly 20,000 people living with HIV in the city [30].…”

New initiatives to develop self-testing for HIV

“…Confidentiality, convenience, immediacy and the opportunity to increase testing frequency are commonly cited benefits of HIVST (22)(23)(24)(25)(29)(30)(31)(32). Barriers tend to be concerns around dislocation from care pathways, the possibility of coercive testing practices, and perceived issues with selfefficacy as well as kit accuracy (31,33,34).…”

“…Non-RCT projects which have provided participants with a number of HIVSTs with instructions to test frequently have shown that distribution in line with this intervention approach is feasible amongst trans gender women in San Francisco (32), and MSM in Brazil and Peru (21).…”