Abstract
BackgroundDespite the many HIV testing models implemented in Africa, the level of HIV testing uptake remains relatively poor, especially among men. The HIV self-testing (HIVST) model offers an additional approach for encouraging men to get tested. This study aimed to synthesise evidence on men’s perspectives regarding HIVST in sub-Saharan Africa (SSA).MethodsThe databases searched included PubMed/MEDLINE, American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations; SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; ERIC; CINAH; PsychInfo; Embase, Sociological , Scopus; and Google Scholar. The World Health Organization (WHO) and The Joint United Nations’ Programme on HIV and AIDS (UNAIDS) websites were further searched. We only extracted qualitative information from the included studies, despite the research method used (qualitative or mixed methods). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), as well as the Mixed Method Appraisal Tool (MMAT) version 2018, were used to determine the methodological quality of the included studies. NVivo version 11 was used for thematic analysis.ResultsA total of 21,184 articles were identified by the initial search criteria, but only 16 articles were included in the data extraction and quality assessment stage. The following key themes emerged: knowledge of HIVST; acceptability of HIVST; need for HIVST counselling; confidentiality of HIVST; convenience of HIVST; and accuracy of HIVST. The study shows that while HIVST provides men with an alternative, confidential and convenient testing model, the potential for psychological and physical harm remains a challenge.ConclusionThe introduction of the HIVST strategy has the potential of improving men’s uptake in HIV testing services, thereby contributing towards addressing the first cascade of the 90–90-90 strategy. While HIVST has a potential for addressing men’s barriers to attending clinic settings, such as confidentiality and convenience, it barely addresses the HIVST counselling and accuracy concerns.
Highlights
Despite the many HIV testing models implemented in Africa, the level of HIV testing uptake remains relatively poor, especially among men
This suggests a particular urgency in regard to designing and implementing innovative strategies to target men for HIV testing services in resource-limited settings in order to address the first cascade of the United Nations’ Programme on HIV and AIDS (UNAIDS) 90–90-90 programme (90% of all people living with HIV should be diagnosed, 90% of people diagnosed with HIV should be started on antiretroviral therapy (ART), and 90% of people started on ART should have a suppressed viral load) [7]
The electronic search strategy identified 21,184 references (Fig. 1), which were screened for titles. 18,824 articles were not selected during the database search stage because they did not meet the inclusion criteria
Summary
Despite the many HIV testing models implemented in Africa, the level of HIV testing uptake remains relatively poor, especially among men. Men living with HIV are more likely to die early compared to their female counterparts, owing to late diagnosis and antiretroviral therapy (ART) being initiated when the HIV is already at an advanced stage [4,5,6] This suggests a particular urgency in regard to designing and implementing innovative strategies to target men for HIV testing services in resource-limited settings in order to address the first cascade of the UNAIDS 90–90-90 programme (90% of all people living with HIV should be diagnosed, 90% of people diagnosed with HIV should be started on ART, and 90% of people started on ART should have a suppressed viral load) [7]. Some of the notable arguments against HIVST involve its high costs, insufficient counselling, and missed opportunities for STI screening [15] Despite these arguments, HIVST has been shown to be widely acceptable in SSA [11, 12, 16], as well as among key population groups [13]. This acceptability has not seemed to have translated into an increase in the uptake of HIVST, especially among men in SSA
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