HIV self-testing as part of a differentiated HIV testing approach: exploring urban and rural adult experiences from KwaZulu-Natal, South Africa using a cross-over study design

Charlene Harichund,Mosa Moshabela,Sinenhlanhla Simelane,Quarraisha Abdool Karim,Pinky Kunene

doi:10.1186/s12889-018-6366-9

Abstract

BackgroundSuboptimal HIV testing rates through available testing approaches such as HIV counselling and testing have directed research efforts toward recognizing the potential of HIV self-testing as an additional testing method. However, HIV self-testing is not readily available within HIV testing facilities and data on how HIV self-testing and HIV counselling and testing will co-exist within HIV testing facilities is limited. Therefore, this study sought to fill this knowledge gap.MethodsForty consenting adults were exposed to HIV counselling and testing and HIV self-testing using a cross-over study design between February 2016 and February 2017 resulting in 80 (20,20) interviews. Participants were randomly exposed to HIV counselling and testing first, followed by self-testing, or HIV self-testing first, followed by counselling and testing. In-depth interviews were conducted at baseline, and after each testing exposure, using a semi-structured interview guide. Interviews were transcribed and translated prior to doing the framework analysis.ResultsSupport through counselling played a central role in the HIV testing process for some participants who desired support or were not confident to perform unsupervised HIV self-testing. The complementary relationship between HIV self-testing and HIV counselling and testing requires a combination of benefits such as availability of counselling, confidence, convenience and confidentiality (4 Cs) derived from HIV self-testing and HIV counselling and testing. Implementation of the 4 Cs will depend on the availability of unsupervised HIV self-testing and/or supervised self-testing with support from HIV counselling and testing.ConclusionsAs treatment and prevention efforts expand, the reasons for and frequency of testing is changing and there is a need to develop differentiated models for providing HIV testing services to meet client’s needs. HIV self-testing is an important addition to enhance HIV testing efforts and should be offered in combination with HCT.

Highlights

Suboptimal HIV testing rates through available testing approaches such as HIV counselling and testing have directed research efforts toward recognizing the potential of HIV self-testing as an additional testing method
The first interview was conducted before the first HIV test, regardless of the assigned study arm; the second after the first HIV test (Fig. 1). Thereafter, those who were assigned to the HIV counselling and testing (HCT) undertook a self-test, and those initially assigned to self-testing were assigned to HCT (Fig. 1)
The third in-depth interview took place immediately after the completion of the second HIV test (Fig. 1). For those in the HIV self-testing (HIVST) group, each participant was provided with a commercially available blood-based HIVST kit that included written and graphical instructions on how to complete the HIV test and were allocated a private space to conduct the self-test. For those in the HCT group, HIV counselling was provided by a counsellor who performed the HIV test as per the standardised HIV testing guidelines of the South African National Department of Health [14]

Summary

Introduction

Suboptimal HIV testing rates through available testing approaches such as HIV counselling and testing have directed research efforts toward recognizing the potential of HIV self-testing as an additional testing method. The World Health Organization (WHO) recommends the use of HIV self-testing (HIVST) as an additional approach to HIV testing services [1] to enhance HIV testing rates [2]. Clinic hours, long waiting times at health care facilities and perceived lack of confidentiality associated with HIV counselling and testing (HCT), impede its uptake [3, 4]. Several HIV testing approaches such as HCT and provider initiated counselling and testing have been added to the HIV testing framework, but have not provided the desired testing uptake due to its dependence of support from health care professionals [11]. While HIVST may require a level of initial supervised support, over time it has the potential to be conducted unsupervised by most individuals [12]

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Conclusion