When healthcare providers are supportive, 'I'd rather not test alone': Exploring uptake and acceptability of HIV self-testing for youth in Zimbabwe - A mixed method study.

Constancia V Mavodza,Tsitsi Bandason,Tsitsi Apollo,Rashida Abbas Ferrand,Chido Dziva Chikwari,Sarah Bernays,Katharina Kranzer,Ethel Dauya,Getrude Ncube,Mandikudza Tembo,Constance R S Mackworth‐Young

doi:10.1002/jia2.25815

Abstract

IntroductionIn sub‐Saharan Africa, less than half of young people know their HIV status. HIV self‐testing (HIVST) is a testing strategy with the potential to offer privacy and autonomy. We aimed to understand the uptake and acceptability of different HIV testing options for youth in Harare, Zimbabwe.MethodsThis study was nested within a cluster randomized trial of a youth‐friendly community‐based integrated HIV and sexual and reproductive health intervention for youth aged 16–24 years. Three HIV testing options were offered: (1) provider‐delivered testing; (2) HIVST on site in a private booth without a provider present; and (3) provision of a test kit to test off site. Descriptive statistics and proportions were used to investigate the uptake of HIV testing in a client sample. A focus group discussion (FGD) with intervention providers alongside in‐depth interviews, paired interviews and FGDs with a selected sample of youth clients explored uptake and acceptability of the different HIV testing strategies. Thematic analysis was used to analyse the qualitative data.ResultsBetween April and June 2019, 951 eligible clients were tested for HIV: 898 (94.4%) chose option 1, 30 (3.25%) chose option 2 and 23 (2.4%) chose option 3. Option 1 clients cited their trust in the service and a desire for immediate counselling, support and guidance from trusted providers as the reasons for their choice. Young people were not confident in their expertise to conduct HIVST. Concerns about limited privacy, confidentiality and lack of support in the event of an HIV‐positive result were barriers for off‐site HIVST.ConclusionsIn the context of supportive, trusted and youth‐friendly providers, youth clients overwhelmingly preferred provider‐delivered HIV testing over client‐initiated HIVST or HIVST off site. This highlights the importance of listening to youth to improve engagement in testing. While young people want autonomy in choosing when, where and how to test, they do not want to necessarily test on their own. They desire quality in‐person counselling, guidance and support, alongside privacy and confidentiality. To increase the appeal of HIVST for youth, greater provision of access to private spaces is required, and accessible pre‐ and post‐test counselling and support may improve uptake.

Highlights

In sub-Saharan Africa, less than half of young people know their HIV status
We investigated the uptake and acceptability of providerdelivered testing compared to HIV self-testing (HIVST) offered as part of an integrated package of health services to youth in communitybased settings in Zimbabwe
Barriers to HIVST for youth included the fear of testing by themselves without support and counselling, the lack of privacy at home, limited confidence in their ability to conduct a self-test and accurately interpret the results and concerns around being able to cope with a positive result

Summary

Introduction

In sub-Saharan Africa, less than half of young people know their HIV status. HIV self-testing (HIVST) is a testing strategy with the potential to offer privacy and autonomy. A focus group discussion (FGD) with intervention providers alongside in-depth interviews, paired interviews and FGDs with a selected sample of youth clients explored uptake and acceptability of the different HIV testing strategies. Conclusions: In the context of supportive, trusted and youth-friendly providers, youth clients overwhelmingly preferred provider-delivered HIV testing over client-initiated HIVST or HIVST off site. This highlights the importance of listening to youth to improve engagement in testing. While young people want autonomy in choosing when, where and how to test, they do not want to necessarily test on their own They desire quality in-person counselling, guidance and support, alongside privacy and confidentiality. Studies have shown high levels of uptake of HIVST among groups with increased HIV exposure, such as men who have sex with men (MSM), sex workers, adolescents (16–19 years) and pregnant women in SSA [6,12,13]

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