Choice in HIV testing: the acceptability and anticipated use of a self-administered at-home oral HIV test among South Africans

Abstract

Combination HIV prevention is being widely promoted by funders. This strategy aims to offer HIV prevention choices that can be selected and combined to decrease HIV risk in ways that fit with each individual's situation. Treatment as prevention and pre-exposure prophylaxis are two new evidence-based strategies to decrease HIV incidence, both of which require high HIV testing rates to be effective, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a goal of 90% of HIV-positive individuals knowing their status by 2030. However, HIV testing rates in many countries remain suboptimal. Just as no single HIV prevention method is ideal for all people in all situations, no single HIV testing modality is likely to be acceptable to everyone. By offering HIV testing choices, we may be able to increase testing rates. However, many low-resourced countries have been slow to take up new HIV testing options such as the self-administered at-home oral HIV test that is currently available in the United States. In this paper, we present findings from 20 in-depth interviews, conducted in 2010, documenting opinions about self-administered at-home oral HIV testing, a testing modality still largely unavailable in Africa. Participants were clients of three primary healthcare clinics in South Africa. Self-testing was seen as enabling confidentiality/privacy, saving time, and facilitating testing together with partners. However, concerns were raised about psychological distress when testing at home without a counsellor. Some suggested this concern could be minimised by having experienced clinic-based HIV testing and counselling before getting self-testing kits for home use. Thus, self-administered HIV testing could be an option added to the current testing modalities to address some important barriers to testing.

Addressing Missed Opportunities for HIV Testing by Including Rapid HIV Self-testing Kits with Patient-Delivered Partner Therapy

“…Interview data provided rationale for why STI clinic patients might be willing to deliver HIVST kits to their partners with PDPT, which could help facilitate disruption of STI and HIV transmission if implemented with favorable uptake. This data supports a growing body of evidence supporting the acceptability of HIVST (Ahmed-Little et al, 2016; Bavinton et al, 2013; Bustamante et al, 2017; Choko et al, 2015; Gaydos et al, 2011; Kelvin et al, 2016; Kurth et al, 2016; Lee, Brooks, Bolan, & Flynn, 2013; Pal et al, 2016; Prestage et al, 2016; Witzel, Rodger, Burns, Rhodes, & Weatherburn, 2016). Moreover, this research adds to prior data on the acceptability of secondary distribution of HIVST kits to sexual partners (Kalibala et al, 2014; Lippman et al, 2016; Masters et al, 2016; Prestage et al, 2016; Thirumurthy et al, 2016), indicating rationale for why individuals might find it acceptable.…”

“…STI clinic stigma is further exacerbated with worries about social network members seeing them at the clinic (Lippman et al, 2016), necessitating the need for PDPT and secondary distribution of HIVST kits to reach some at-risk populations. Providing HIVST kits with PDPT was described as a convenient mechanism to overcome this barrier, consistent with prior findings about the convenience associated with HIVST (Ahmed-Little et al, 2016; Bavinton et al, 2013; Kelvin et al, 2016; Lippman et al, 2016; Witzel et al, 2016). …”

“…Moreover, this research adds to prior data on the acceptability of secondary distribution of HIVST kits to sexual partners (Kalibala et al, 2014; Lippman et al, 2016; Masters et al, 2016; Prestage et al, 2016; Thirumurthy et al, 2016), indicating rationale for why individuals might find it acceptable. Patients supported the idea of bringing HIVST kits to partners when delivering PDPT because it was perceived to provide extra safety against HIV, consistent with other research findings about patients’ desires to make more informed decision-making regarding sexual behaviors with their partners (Kelvin et al, 2016; Lippman et al, 2016). Support for earlier identification of people living with HIV was discussed by participants to reduce the negative health implications of untreated infections for their partners and continued risk of HIV transmission.…”

“…These findings align with prior research that found patients desire counseling before and after HIVST (Pal et al, 2016), highlighting the need for social support systems for partners’ self-testing. HIVST with a partner was seen to inform perceptions of support (Lippman et al, 2016), and patients in primary care have described the need to play the role of HIV counsellor with their partners—perceiving a need to take responsibility for helping their partners link to care for confirmatory testing and treatment (Kelvin et al, 2016). Further efforts are needed to prepare patients and partners for HIVST given the enormity of an HIV-positive test result and the necessity for follow-up counseling, testing, and treatment.…”

Evaluating oral HIV self-testing to increase HIV testing uptake among truck drivers in Kenya

“…This is also consistent with the in-depth interviews, which found that participants who did not test at baseline or over follow-up had strong -but varied -preferences regarding the biological specimen used for the HIV test (oral fluid or blood). This variation in preference for blood versus oral HIV tests was also found in a qualitative study looking at views on oral self-testing among a sample of South African clinic attendees (Kelvin et al 2016). …”