Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

Abstract

Background: Many southern African countries are nearing the global goal of diagnosing 90% of people with HIV by 2020. In 2016, 84 and 86% of people with HIV knew their status in Malawi and Zimbabwe, respectively. However, gaps remain, particularly among men. We investigated awareness and use of, and willingness to self-test for HIV and explored sociodemographic associations before large-scale implementation. Methods: We pooled responses from two of the first cross-sectional Demographic and Health Surveys to include HIV self-testing (HIVST) questions in Malawi and Zimbabwe in 2015-16. We investigated sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and past use, awareness of, and future willingness to self-test using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with a completed questionnaire and valid HIV test result. We restricted analysis of willingness to self-test to Zimbabwean men, as women and Malawians were not systematically asked this question. Results: Of 31,385 individuals, 31.2% of men had never tested compared with 16.5% of women (p < 0.001). For men, the likelihood of having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2 and 12.6%, respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio [aOR] = 1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with greater willingness associated with having previously tested for HIV, being at high sexual risk (highest willingness [aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009]), and being ≥25 years old. Wealthier men had greater awareness of HIVST than poorer men (p < 0.001). The highest willingness to self-test (aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009) was among men at high HIV-related sexual risk.

Implementation of HIV Self-Testing to Reach Men in Rural uMkhanyakude, KwaZulu-Natal, South Africa. a DO-ART Trial Sub Study

“…Fourteen percent of those who took HIVST kits reported to have never tested for HIV, 98% were men, and of those, 80% were below the age of 35. These results support findings by Johnson et al, where it was found that willingness to self-test by Zimbabwean men was high at around 85% (21). These results are also consistent with other multiple reports that have suggested that HIVST can increase uptake of testing among high risk groups that are under-represented in HIV testing programs (22)(23)(24)(25)(26)(27).…”

Uptake of HIV/AIDS Services Following a Positive Self-Test Is Lower in Men Than Women in the Democratic Republic of the Congo

“…Participants self-reported the information regarding the risk for HIV. Individuals exposed to any of these factors were classified as "high risk"; the remaining participants were classified as "low risk" if they did not report any sexual activity in the past 6 weeks and as "moderate risk" if otherwise (9,21,22). Educational level was categorized according to the educational system of the DRC, as follows: (i) low: unschooled or attending primary school; (ii) middle: attending college (training of 6 years) or technical school (training of 4 years); and (iii) high: attending bachelor's degree, graduate degree (training of 2 years after Bachelor's degree), or postgraduate degree, as previously reported ( 6).…”

“…As shown in Table 2, multivariate analysis showed that male gender (adjusted OR: 0.7, 95% CI: 0.5-0.9) was significantly £ High risk for HIV infection was defined as a history of unprotected sex with one or more partners in the past 6 weeks as well as exposure to any of the following high-risk factors in the previous 6 months: multiple (i.e., >2) partners; homosexual intercourse (asked of men); receipt of gifts, cash, or other compensation in exchange for sex (asked of women); or infection with another sexually transmitted disease. Individuals exposed to any of these factors were classified as "high risk"; the remaining participants were classified as "low risk" if they did not report any sexual activity in the past 6 weeks and as "moderate risk" if otherwise (9,21,22).…”

Field evaluation of capillary blood and oral-fluid HIV self-tests in the Democratic Republic of the Congo

“…�2) partners, homosexual intercourse (asked of men), receipt of gifts, cash, or other compensation in exchange for sex (asked of women), or infection with another sexually transmitted disease. Individuals exposed to any of these factors were classified as "high risk"; the remaining participants were classified as "low risk" if they did not report any sexual activity in the past six weeks, and as "moderate risk" otherwise [21,22].…”