Usability of three blood-based HIV self-testing devices among men who have sex with men and female sex workers in Yaounde and Douala, Cameroon

Abstract

Background Blood-based HIV self-testing represents an alternative for increasing screening among key populations or populations with difficult access. In Cameroon, very few studies, on the usability of HIV self-tests based on blood samples, have been carried out among these groups. Objective The aim of this study was to assess the usability of blood-based HIV self-testing among men who have sex with men (MSM) and female sex workers (FSWs) in the cities of Yaoundé and Douala, Cameroon. Materials and Methods An observational study was conducted in 17 Community-Based Organisations (CBOs), including 10 MSM and 07 FSWs in Yaoundé and Douala from 11 to 22 June 2022. The study population consisted of HCV and MSM aged 21 years and over who agreed to participate in the study. After they were recruited consecutively in their respective CBOs, they received counselling, unassisted HIV blood self-testing and condoms. Data was collected using an administered questionnaire. Three HIV blood self-testing devices were used in the study: Mylan HIV Self-Test, Sure Check HIV Test® (Chembio Diagnostics Inc), Check Now HIV Self-Test(Abbott™ Point Of Care). Analysis was conducted using SPSS 23 software with a 95% confidence level. Results Of 817 participants who completed the HIV blood self-test, just over half were TS 459(56.2%); the median age was 27 years (IQR: 22 years - 34 years) and the 25-49 age group was most represented 482(59.0%). One participant in ten (10%) had never been tested for HIV. However, 98.6% of participants agreed to use the HIV blood self-test and the vast majority (97.1%) followed the steps for carrying out the HIV blood self-test. An MSM was 4 times more likely to pass an HIV blood self-test than a TS (aOR= 4.01; 95% CI: 1.181-13.625; p=0.026). Similarly, TS and MSM who used the Abbott Check Now HIV Self-Test (aOR= 3.85; 95% CI: 1.246-11.908; p=0.019) and Chembio Sure Check HIV Test (aOR= 2.83; 95% CI: 1.072-7.720; p=0.036) were respectively 3.8 and 2.8 times and more likely to pass their self-test than those who used the Mylan blood self-test. Agreement between a participant's HIV blood self-test result and Abbott-trained investigator-observers was moderate (κ=0.485; CI95% (0.359-0.610); p=0.001) while agreement with Chembio and Mylan was respectively low (κ=0.329; CI95% (0.203-0.454); p=0.001) and very low (κ=0.194; CI95%(0.05-0.329); p=0.001). Conclusion HIV blood self-testing is acceptable and usable by key populations in Cameroon. Although usability was limited by problems in interpreting results and incorrect disposal of waste t by key populations, a blood-based HIV Self-Test, with moderate concordance, proved suitable for unassisted use in key populations, what could help improve HIV prevention interventions.