Abstract
Background:Opportunities for HIV testing could be enhanced by offering HIV self-testing (HIVST) in populations that fear stigma and discrimination when accessing conventional HIV counselling and testing. Field experience with HIVST was poorly reported in French-speaking African countries.Objective:To investigate the usability of HIVST in Bangui, Central African Republic.Methods:The prototype self-test Exacto® Test HIV (Biosynex, Strasbourg, France) was used to assess the usability of HIVST in 300 adults living in Bangui, according to WHO technical recommendations. Simplified and easy-to-read leaflet was translated in French and Sango.Results:Preliminary survey in 3,484 adult volunteers including students, men who have sex with men and female sex workers living in Bangui showed that previous HIV testing in conventional centres for HIV counselling and testing was relatively infrequent and that acceptability of HIVST was elevated, although high heterogeneity could be observed between groups. The notice in French and Sango of Exacto® Test HIV were chosen in 242/300 (80.6%) and 58/300 (19.4%), respectively. It was correctly understood in 273/300 (91.0%). The majority (275/300; 91.6%) correctly performed the HIV self-test; however, 71/300 (23.0%) asked for oral assistance. Most of the participants (273/300; 91.0%) found that performing of the self-test was very easy or easy, and less than Most of participants (273/300; 91.0%) found that performing of the self-test was very easy or easy and less than 1.0% (2/300) found it difficult. Overall the result were correctly interpreted in 96.9% (3,782/3,900), the reading/interpretion errors concerned the positive (96/1,800;5.3%), invalid (17/600;2.8%) and negative (5/1,500; 0.3%) self-test. The Cohen's coefficient κwas 0.94. The main obstacle for HIVST was the educational level, with interpretation difficulties in poorly educated people.Conclusions:Our observations on profane adults living in Central African Republic, demonstrate: (i) the need to adapt the notice of instruction to African public, including educational pictograms as well as notice in vernacular language(s); (ii) the frequent difficulties in understanding the notice with frequent misinterpretation of test results; (iii) and the generally good usability of the HIV self-test despite these latter pitfalls. More research on exploring the best strategy (i.e. supervised versus unsupervised strategies) for different high- and low- risk populations in resource-constrained settings remains needed.
Highlights
Reaching universal HIV status awareness is crucial to ensure that all HIV-infected patients will have access to antiretroviral treatment and achieve virological suppression
“official” or “professional” female sex workers (FSW) (33%) who report themselves to have their main resources from paid sexual transactions are divided in two categories: the so-called “pupulenge” (14%), i.e. dragonflies consisting of roamers, who travel around the city to hotels and nightclubs seeking wealthy clients, and the category of “kata”, (19%), i.e. whores working in poor neighbourhoods
The majority of individuals involved in the survey had ever heard of HIV self-testing (HIVST) (77-98%), were willing to use HIVST if it was available (69-97%), though that post-testing counselling is necessary to HIVST (74-95%) and were willing to test their partner using HIVST kits (52-98%)
Summary
Reaching universal HIV status awareness is crucial to ensure that all HIV-infected patients will have access to antiretroviral treatment and achieve virological suppression. HIV self-testing (HIVST) represents an innovative strategy to expand access to HIV testing services in the general population and to reach individuals at high risk for HIV who may not otherwise carry out HIV testing, including young people and key populations [7, 8]. HIVST only does not appear to increase linkage to care and studies have shown that additional interventions may be required [19] Based on these preliminary observations, HIVST has been proposed as a way to address the challenges of efficiently reaching people at risk for or with an undiagnosed HIV infection who may not test otherwise [20]. Field experience with HIVST was poorly reported in French-speaking African countries
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