Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis

Abstract

Background: Despite the many HIV testing models implemented in Africa, the level of HIV testing uptake remains relatively poor, especially among men. The HIV self-testing (HIVST) model offers an additional approach for encouraging men to get tested. This study aimed to synthesise evidence on men's perspectives regarding HIVST in sub-Saharan Africa (SSA). Methods: The databases searched included PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations; SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; ERIC; CINAH; PsychInfo; Embase, Sociological Abstract, Scopus; and Google Scholar. The World Health Organization (WHO) and The Joint United Nations' Programme on HIV and AIDS (UNAIDS) websites were further searched. We only extracted qualitative information from the included studies, despite the research method used (qualitative or mixed methods). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), as well as the Mixed Method Appraisal Tool (MMAT) version 2018, were used to determine the methodological quality of the included studies. NVivo version 11 was used for thematic analysis. Results: A total of 21,184 articles were identified by the initial search criteria, but only 16 articles were included in the data extraction and quality assessment stage. The following key themes emerged: knowledge of HIVST; acceptability of HIVST; need for HIVST counselling; confidentiality of HIVST; convenience of HIVST; and accuracy of HIVST. The study shows that while HIVST provides men with an alternative, confidential and convenient testing model, the potential for psychological and physical harm remains a challenge. Conclusion: The introduction of the HIVST strategy has the potential of improving men's uptake in HIV testing services, thereby contributing towards addressing the first cascade of the 90-90-90 strategy. While HIVST has a potential for addressing men's barriers to attending clinic settings, such as confidentiality and convenience, it barely addresses the HIVST counselling and accuracy concerns.

Key Stakeholders’ Perspectives on Implementation and Scale up of HIV Self-Testing in Rwanda

“…This corroborates well with findings from a similar study conducted in South Africa, which demonstrated key stakeholders' confidence in HIVST improving uptake of HTS in underserved population [31]. A recently published systematic review and meta-synthesis on men's perspectives on HIV self-testing in sub-Saharan Africa recommended presented evidence of poor awareness but high acceptability of HIVST among men [32]. While this is the case; stakeholders expressed concerns that need to be addressed before effective implementation and scale-up can be achieved.…”

“…Raising public awareness levels emerged as a key strategy to effective implementation and overall success of scale-up efforts in this study. Similar recommendations have been made elsewhere [31,32,36,37]. Key stakeholders in South Africa [31], researchers, academics, journalists, community advocates, policy makers and other key stakeholders in Nigeria [36] and reviews by Hlongwa et al [32], Johnson et al [37] all recommend need the improve public awareness on HIVST.…”

“…Similar recommendations have been made elsewhere [31,32,36,37]. Key stakeholders in South Africa [31], researchers, academics, journalists, community advocates, policy makers and other key stakeholders in Nigeria [36] and reviews by Hlongwa et al [32], Johnson et al [37] all recommend need the improve public awareness on HIVST. Similar to the findings of the current study, ensuring that kits are affordable has been recommended by key stakeholders in South Africa [31,33] and potential users in Singapore [10].…”

Level of knowledge, acceptability, and willingness to use oral fluid HIV self-testing among medical students in Kilimanjaro region, Tanzania: a descriptive cross-sectional study

“…Existing evidence suggests that by allowing people to test discreetly and conveniently, HIVST may increase uptake of HIV testing among people not reached by other HIV testing services [10]. According to the WHO, HIVST is defined as: "a process whereby someone collects his or her specimen (oral fluid or blood) and then performs an HIV test and interprets the result, often in a private setting, either alone or with someone he or she trusts" [1].…”

“…Benefits of HIVST reported in the literature, including reaching first-time testers, older men, and very young and vulnerable people, men who sex with men (MSM), commercial sex workers, and transgender [10][11][12][13][14][15]. Also, HIVST has the advantages of convenience, privacy, anonymity, and a short time to get results, confidentiality, and accessibility.…”