Enablers and barriers to effective HIV self-testing in the private sector among sexually active youths in Nigeria: A qualitative study using journey map methodology

Abstract

Background HIV is a public health burden in Nigeria. HIV self-testing is one of the approaches to testing, which is the first of the 95:95:95 cascade of a coherent response to the epidemic. The ability to self-test HIV is influenced by various factors that can either serve as enablers or barriers. Exploring these enablers and barriers to the uptake of HIVST will help achieve optimal HIV self-testing and provide a deeper understanding of the HIVST kits users’ journey. Objective The purpose of the study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. Methods We conducted a qualitative exploratory study between January 2021 to October 2021 to understand the journey map for taking up and using HIVST in the private health delivery systems which include the pharmacies and PPMVs. 80 youths in Lagos, Anambra and Kano states were interviewed using IDIs and in-person FGDs. Their responses were audio-recorded, transcribed and analyzed using a qualitative software package (Nvivo software). Results A journey map for taking up and effectively using HIVST using the private sector among sexually active youths using key enablers and barriers at the attract, purchase, use, confirmation, linkage, and reporting stage was developed. The major enablers among participants were privacy and confidentiality, bundling purchases with other health products, easy-to-use instructions, and past experience with other self-testing kits. The major barriers were fear of discrimination, big packaging, high price, lack of confidence from user error and fear of status disclosure. Conclusions Sexually active young people’s perspectives enhance our understanding of the barriers and enablers of using HIVST through the private sector. Optimizing the enablers such as improved confidentiality that may be seen in e-pharmacy, reducing barriers and factoring sexually young people’s perspectives will enhance the market and the uptake of HIVST towards ensuring sustainability and accelerating progress towards the 95-95-95 targets.

HIV self-testing and its associated factors among young university students: A cross-sectional study in a Public University in Uganda

“…Previous studies have underscored that young adult find HIVST to be more convenient, easy to use, efficient, and that it saves time and money [16][17][18]. This was consistent with our study findings where young adults preferred HIVST and the majority of them used HIVST because it was more convenient for them.…”

“…Our study findings were consistent with studies which cited lack of counselling as a major deterrent for uptake of HIVST [10,20]. The lack of counselling in HIVST has been suggested to result in genderbased violence, emotional distress, suicide and self-harm though evidence to that effect is currently lacking [14,18,20]. This may be because individuals who opt for HIV self-testing are informed that HIVST does not confirm the HIV status but that it serves to screen for HIV [9].…”

“…Young adults in our study who preferred provider-based HIV testing over HIVST did so because testing in the health facilities were seen to provide more accurate, trustworthy, credible, and reliable test results. Although the accuracy of test results in HIVST is equivalent to that from health facility-based HIV testing [15,19], previous studies have underscored young adults' scepticism over the accuracy of test results obtained from HIVST [18,20].…”

Assessing the Impact of use of HIV self-testing on the incidence of HIV Infection in Nigeria: a systematic review and meta-analysis

“…The i-Test program for adolescents in Nigeria positions HIV self-testing as a hygiene product is an example of rebranding HIV testing for target population [14]. There are studies also exploring the utilization of HIV self-testing by adolescents in the private sector [53], the use of social network interventions for reaching hard-to-reach populations [54], the door-to-door distribution of test kit approach [55], secondary distribution of kits via peers, sexual partners, and female sex workers [56] and targeted interventions at places where at-risk populations congregate and train laypersons such as patent medicine vendors, promote rapid testing [57]. Effective combination of these context-specific strategies and interventions can improve on the use of HIV self-testing in Nigeria.…”

Advancing Programme Science approaches to understand gaps in HIV prevention programme coverage for key populations in 12 Nigerian states: findings from the 2020 Integrated Biological and Behavioural Surveillance Survey

“…It is plausible that members of key population groups, who generally receive intensified HIV prevention messaging, could be acquiring condoms independent of outreach‐based services. Similarly, HIV testing is widely promoted among key populations and while primarily accessed through outreach‐based platforms, they are also readily available via non‐outreach‐based modalities, including government and private facilities, pharmacies, mobile clinics and self‐testing options across Nigeria [ 15 , 52 , 53 , 54 , 55 , 56 ].…”