Abstract
BackgroundAlthough HIV self-testing (HIVST) is globally accepted as an important complement to existing HIV testing approaches, South Africa has lagged behind in its adoption. As a result, data on the acceptability and uptake of HIVST testing is limited. The study investigated the acceptability of HIVST among students in Technical Vocational Education and Training (TVET) colleges in two provinces in South Africa.MethodsA cross-sectional survey using a self-administered structured questionnaire was used to collect data among 3,662 students recruited from 13 TVET colleges.ResultsThe mean age of the students was 21.9 years. The majority (80.9%) were sexually active; while 66.1% reported that they had one sexual partner, and 33.9% had two or more sexual partners in the past year, and66.5% used condoms during the last sexual act. Three-quarters tested for HIV in the past year but less than half knew about HIVST prior to the survey. The acceptability of HIVST was high; about three-quarters showed a willingness to purchase a self-test kit and a majority would self-test with partners. Acceptability of HIVST was associated with being sexually active (OR = 1.73, p = 0.02, confidence interval (CI): 1.08–2.75), having ever been tested for HIV (OR = 1.74, p = 0.001, CI: 1.26–2.38), and having multiple sexual partners (OR = 0.61, p = 0.01, CI: 0.42–0.88). Three-quarters would confirm test results at a local health facility. In terms of counselling, telephone hotlines were acceptable to only 39.9%, and less than half felt that test-kit leaflets would provide sufficient information to self-test.InterpretationsThe high acceptability of HIVST among the students calls for extensive planning and preparation for the scaling up of HIVST in South Africa. In addition, campaigns similar to those conducted to promote HIV counselling and testing (HCT) should be considered to educate communities about HIVST.
Highlights
HIV self-testing (HIVST) is globally accepted as an important complement to existing HIV testing approaches, South Africa has lagged behind in its adoption
Three-quarters tested for HIV in the past year but less than half knew about HIVST prior to the survey
A majority of the Technical Vocational Education and Training (TVET) college students already utilise HIV counselling and testing (HCT) in public health facilities, and a vast majority have high levels of acceptability for HIVST and intention to test with partners
Summary
A cross-sectional survey using a self-administered structured questionnaire was used to collect data among 3,662 students recruited from 13 TVET colleges. A formative evaluation design using the mixed approach was employed to assess the opinions of and acceptability of HIVST among TVET college students. Since TVET colleges offer different types of qualification, to allow for variability of student participation by qualification type, all colleges were approached to participate in the study in order to minimize selection bias and to accommodate for refusal of institutional permission from college management. A survey was conducted in 12 TVET colleges after permission was granted by the college principals. Cluster sampling consisting of levels of study of the National Certificate Course (N1 to N6) was used to produce a representative sample of students. The total number of students who volunteered to participate in the study were 3662
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