Barriers and facilitators to facility HIV self-testing in outpatient settings in Malawi: a qualitative study

Abstract

Background Facility HIV self-testing (HIVST) within outpatient departments can increase HIV testing coverage by facilitating HIVST use in outpatient waiting spaces while clients wait for routine care. Facility HIVST allows for the majority of outpatients to test with minimal health care worker time requirements. However, barriers and facilitators to outpatients’ use of facility HIVST are still unknown. Methods As part of a cluster randomized trial on facility HIVST in Malawi, we conducted in-depth interviews with 57 adult outpatients (> 15 years) who were exposed to the HIVST intervention and collected observational journals that documented study staff observations from facility waiting spaces where HIVST was implemented. Translated and transcribed data were analyzed using constant comparison analysis in Atlas.ti. Results Facility HIVST was convenient, fast, and provided autonomy to outpatients. The strategy also had novel facilitators for testing, such as increased motivation to test due to seeing others test, immediate support for HIVST use, and easy access to additional HIV services in the health facility. Barriers to facility HIVST included fear of judgment from others and unwanted status disclosure due to lack of privacy. Desired changes to the intervention included private, separate spaces for kit use and interpretation and increased opportunity for disclosure and post-test counseling. Conclusions Facility HIVST was largely acceptable to outpatients in Malawi with novel facilitators that are unique to facility HIVST in OPD waiting spaces. Trial registration The parent trial is registered with ClinicalTrials.gov, NCT03271307, and Pan African Clinical Trials, PACTR201711002697316.

Facility HIV Self-Testing in Outpatient Departments: An Assessment of Characteristics and Concerns of Outpatients Who Opt Out of Testing in Malawi

“…Provision of private spaces as part of HIVST programs for viewing results is crucial to encourage shy adult women test for HIV. 27 Our study observed higher risk of opting out among urban populations as compared with rural residents for both men and women. This is consistent with other HIV testing studies that report low uptake of testing among urban populations across the region.…”

“…Provision of private spaces as part of HIVST programs for viewing results is crucial to encourage shy adult women test for HIV. 27…”

Manuscript Title: Facility-based HIV self-testing as an additional testing option in health facilities: A systematic review and meta-analysis

“…The searches yielded 2,203 citations, of which, 11 studies were deemed eligible, including 4 randomized controlled trials [4,[13][14][15], 2 prospective single-arm cohort studies [16,17], 2 qualitative studies employing individually-based in-depth interviews (IDI) [18,19], 2 costing studies [20,21] and 1 costeffective analysis [22] (Figure 1). Malawi, including a costing study [20], a modelled cost-effectiveness study [22], and a qualitative study [18], targeting adolescent & adult outpatients in high burden health facilities. The remaining RCTs [13][14][15] were individual RCTs, targeting truck drivers and female sex workers at roadside wellness clinics in Kenya.…”

Facility‐based HIV self‐testing strategies may substantially and cost‐effectively increase the number of men and youth tested for HIV in Malawi: results from an individual‐based mathematical model

“…HIVST is consistently shown to increase testing rates in comparison with standard PITC models, even in randomized controlled trials where providers receive additional support for implementing PITC [ 11 , 12 , 14 , 21 ]. There is consensus that HIVST is associated with a higher absolute number of patients on treatment for HIV, although linkage rates differ based on the HIVST implementation [ 11 , 14 , 21 ] and antiretroviral treament (ART) initiation has been lower among those diagnosed through self‐testing in comparison to PITC [ 14 , 22 ]. Hybrid facility‐based PITC + HIVST strategies may allow health facilities to maximize the benefits of both modalities, increasing coverage and reducing personnel costs without sacrificing quality of and linkage to care.…”