Uptake and Acceptability of Oral HIV Self-Testing among Community Pharmacy Clients in Kenya: A Feasibility Study

Abstract

BackgroundWhile HIV testing and counselling is a key entry point for treatment as prevention, over half of HIV-infected adults in Kenya are unaware they are infected. Offering HIV self-testing (HST) at community pharmacies may enhance detection of undiagnosed infections. We assessed the feasibility of pharmacy-based HST in Coastal Kenya.MethodsStaff at five pharmacies, supported by on-site research assistants, recruited adult clients (≥18 years) seeking services indicative of HIV risk. Participants were offered oral HST kits (OraQuick®) at US$1 per test. Within one week of buying a test, participants were contacted for post-test data collection and counselling. The primary outcome was test uptake, defined as the proportion of invited clients who bought tests. Views of participating pharmacy staff were solicited in feedback sessions during and after the study.ResultsBetween November 2015 and April 2016, 463 clients were invited to participate; 174 (38%) were enrolled; and 161 (35% [95% Confidence Interval (CI) 31–39%]) bought a test. Uptake was higher among clients seeking HIV testing compared to those seeking other services (84% vs. 11%, adjusted risk ratio 6.9 [95% CI 4.9–9.8]). Only 4% of non-testers (11/302) stated inability to pay as the reason they did not take up the test. All but one tester reported the process was easy (29%) or very easy (70%). Demand for HST kits persisted after the study and participating service providers expressed interest in continuing to offer the service.ConclusionsPharmacy HST is feasible in Kenya and may be in high demand. The uptake pattern observed suggests that a client-initiated approach is more feasible compared to pharmacy-initiated testing. Price is unlikely to be a barrier if set at about US$1 per test. Further implementation research is required to assess uptake, yield, and linkage to care on a larger scale.

HIV testing preferences among pregnant women attending antenatal care and their male partners: a discrete choice experiment in Uganda

“…Our findings among pregnant women and their male partners in Uganda provide valuable evidence around HIV testing preferences, demonstrating statistically significant overall preferences for an oral over a finger prick test, and a nurse-administered test over a self-test. We do not, however, interpret our finding of a preference for a nurse-administered test as running counter to the results of previous studies demonstrating high acceptability of HIV oral self-testing (Burke et al, 2017;Choko et al, 2017;Figueroa et al, 2015;Gumede & Sibiya, 2018;Harichund et al, 2019;Mugo et al, 2017;Stevens et al, 2018). Indeed, in the intervention arm of our Uganda study, participants did demonstrate a high acceptability of HIV oral self-testing, with 93.5% of women passing the kit to their male partners, overall 77.2% of male partners testing for HIV, and 81.5% of these men choosing to test via the oral self-testing kit (Korte et al, n.d.).…”

Demand for self‐tests: Evidence from a Becker–DeGroot–Marschak mechanism field experiment

“…Masters et al (2016) and Thirumurthy et al (2016) measure take-up of HIV self-tests at zero price in a sample of 600 individuals and couples in a field experiment Kisumu, Kenya, finding take-up ranging from 62% to 91%. Mugo et al (2017) measures take-up for HIV self-tests at a price of US$1 among 463 pharmacy clients in Kenya and finds take-up of 35%. Thirumurthy et al (2018) measures stated WTP in Kisumu, Kenya, finding that 12% participants had WTP equal to zero, approximately 35% of participants had WTP less than 50 Ksh, and 29% of participants had WTP greater than 100 Ksh.…”

HOSENG trial – Effect of the provision of oral self-testing for absent and refusing individuals during a door-to-door HIV testing campaign on testing coverage: protocol of a cluster randomized clinical trial in rural Lesotho

“…HIV self-testing (HIVST) has proved to be an accurate diagnostic tool that increases uptake of HIVtesting, facilitates linkage to care among target populations, and may be more cost-effective than providerdelivered HIV-testing [9][10][11][12][13][14][15][16][17]. Thus, WHO strongly endorses oral HIVST [18].…”