Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study

ABSTRACT

Uptake of HIV testing remains low among men in South Africa. As part of a trial, we assessed the acceptability of a theoretically derived and adapted tablet-based-application (EPIC-HIV1) in rural South Africa. We conducted 20 in-depth interviews with men aged ≥18 years and offered a tablet-based survey to all men aged ≥15 years who received EPIC-HIV1 (Sep-Dec 2018). We conducted a descriptive analysis of the survey and used Self-Determination Theory (SDT) to guide our thematic analysis. A total of 232/307 (75%) completed the survey, 55% of whom were aged 15–24 years. 96%[ CI: 92.8–98.2%; n = 223] found EPIC-HIV1 acceptable and 77% [95% CI: 71.8–82.6%; n = 179] found it user-friendly. 222 [96%] reported that EPIC-HIV1 motivated them to test; 83% (192/232) tested for HIV, of which 33% (64/192) were first time testers. Those who did not consent (n = 40) were more likely to have had an HIV-positive test result. Participants reported that the app boosted their confidence to test. However, they were unsure that the app would help them overcome barriers to test in local clinics. Given reach and usability, an adapted SDT male-tailored app was found to be acceptable and could encourage positive health-seeking behavioural change among men.

KEYWORDS:

• Mhealth
• home-based testing
• men and HIV
• process evaluation
• South Africa

Acknowledgements

The authors wish to thank the colleagues at AHRI supporting day-to-day project operations; Anya Zeitlin, who led the user-centred design of EPIC-HIV1; the fieldworkers and all the study participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The research is funded by the National Institutes for Health (NIH). This trial was awarded under National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number R01AI124389. The Africa Health Research Institute’s Demographic Surveillance Information System and Population Intervention Programme is funded by the Wellcome Trust (201433/Z/16/Z), and the South Africa Population Research Infrastructure Network (funded by the South African Department of Science and Technology and hosted by the South African Medical Research Council). EPIC-HIV development was supported by a PRF from the ESPRC IRC Early-warning Sensing Systems for Infectious Diseases (i-sense) EP/K031953/1. Frank Tanser and Till Bäernighausen are also supported by NICHD of NIH (R01-HD084233). Nuala McGrath is a recipient of an NIHR Research Professorship award (Ref:RP:2017-08-ST2-008). Africa Health Research Institute is supported by core funding from the Wellcome Trust [Core grant number (082384/Z/07/Z)]. The funders have no role in the study design, data collection, management, manuscript writing or decision to submit the report for publication.