Acceptability of HIV self-testing: a systematic literature review

Abstract

BackgroundThe uptake of HIV testing and counselling services remains low in risk groups around the world. Fear of stigmatisation, discrimination and breach of confidentiality results in low service usage among risk groups. HIV self-testing (HST) is a confidential HIV testing option that enables people to find out their status in the privacy of their homes. We evaluated the acceptability of HST and the benefits and challenges linked to the introduction of HST.MethodsA literature review was conducted on the acceptability of HST in projects in which HST was offered to study participants. Besides acceptability rates of HST, accuracy rates of self-testing, referral rates of HIV-positive individuals into medical care, disclosure rates and rates of first-time testers were assessed. In addition, the utilisation rate of a telephone hotline for counselling issues and clients` attitudes towards HST were extracted.ResultsEleven studies met the inclusion criteria (HST had been offered effectively to study participants and had been administered by participants themselves) and demonstrated universally high acceptability of HST among study populations. Studies included populations from resource poor settings (Kenya and Malawi) and from high-income countries (USA, Spain and Singapore). The majority of study participants were able to perform HST accurately with no or little support from trained staff. Participants appreciated the confidentiality and privacy but felt that the provision of adequate counselling services was inadequate.ConclusionsThe review demonstrates that HST is an acceptable testing alternative for risk groups and can be performed accurately by the majority of self-testers. Clients especially value the privacy and confidentiality of HST. Linkage to counselling as well as to treatment and care services remain major challenges.

What Should the Ideal HIV Self-Test Look Like? A Usability Study of Test Prototypes in Unsupervised HIV Self-Testing in Kenya, Malawi, and South Africa

“…These findings are consistent with previous study findings that have found HIV testing to be acceptable among various populations, demonstrating the potential of HIVST as a strategy that may improve access to HIV testing [3].…”

“…A review of 11 studies across different contexts suggested HIVST has high acceptability in most instances and increases the reach of HIV testing services with users capable of providing accurate results [3]. Data indicating user preference for oral or blood rapid tests are weak; however, users generally have more difficulty performing blood-based rapid tests [4,5].…”

HIV Self-Testing in Resource-Limited Settings: Regulatory and Policy Considerations

“…As such, they must meet minimum performance standards, and diagnoses are made only through validated, multi-test algorithms [2,7]. Nevertheless, benefits of HIVST within specific settings and populations have now been documented in literature reviews [8][9][10], pilot studies [11][12][13], meeting reports [14], technical updates [15], and interim data and research [16][17][18].…”

Community-Based Rapid HIV Testing in Brazil for Vulnerable Populations: Whom are We Reaching?

“…Importantly, non-invasive options for specimen collection, such as saliva-based tests, can facilitate access to and acceptability of HIV testing [13]. Peer outreach activities have demonstrated to be effective in some countries, and income levels have increased the usage of HIV testing among key populations, such as MSM and individuals engaged in SW.…”