Acceptability, perceived reliability and challenges associated with distributing HIV self‐test kits to young MSM in Uganda: a qualitative study

Abstract

Introduction HIV self‐testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the acceptability, perceived reliability and challenges associated with distributing HIV self‐test (HIVST) to young men who have sex with men (MSM) in Uganda. Methods Between February and May, 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management. Results MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non‐painful; and non‐stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop‐in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services. Conclusions Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow‐up, linkage to HIV care and prevention services are needed for effective results.

Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study

“…HIV testing is the entry point to HIV care; increasing testing coverage is a key step to reaching the first UNAIDS 90-90-90 target, i.e., 90% of people living with HIV knowing their HIV status. However, testing uptake is still low among MSM despite efforts to scale up prevention services for key populations (KP) in Uganda [5][6][7][8]. A recent bio-behavioral survey of Ugandan MSM found that 35% had never tested for HIV [6].…”

“…A recent bio-behavioral survey of Ugandan MSM found that 35% had never tested for HIV [6]. HIV self-testing (HIVST), in which an individual performs and interprets his/her own HIV test [8][9][10][11][12][13], is an acceptable and innovative approach that could increase knowledge of HIV sero-status among MSM, and is recommended by the World Health Organization and Uganda Ministry of Health [3,[14][15][16][17][18][19][20][21][22]. In addition, HIVST is convenient since individuals can test at any time, in private, without having to present to a clinic during fixed working hours.…”

“…In addition, HIVST is convenient since individuals can test at any time, in private, without having to present to a clinic during fixed working hours. In Uganda, healthcare stigma, discrimination, homophobic violence and criminalization are significant barriers to uptake of facilitybased HIV testing among MSM [4,6,8,23]. Scaling up access to HIVST could increase testing coverage among MSM with low access to facility-based services [3,6].…”

Young Key Populations Left Behind: The Necessity for a Targeted Response in Mozambique    

“…Thus, both behavioral and structural interventions are of paramount importance and the participatory engagement of youth in the design and implementation of programming for a targeted response cannot be ignored (2,24,38,(40)(41)(42). UNAIDS outlines the importance of capacity building initiatives of youth-led organizations and associations to ensure their ability to mobilize and advocate for their peers (3).…”

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

“…Although these studies have accessed HIVST acceptability by MSM, few have explored how previous testing experiences differs in its associated factors with acceptability, especially among those who were never tested as compared to those who had a previous HIV negative result. Both groups could potentially bene t from access to additional testing services [36]. Moreover, there are no studies of HIVST acceptability among a large population sample of Brazilian MSM.…”