Awareness of and willingness to use oral HIV self-test kits among Kenyan young adults living in informal urban settlements: a cross-sectional survey

ABSTRACT

Self-administered HIV testing may be a promising strategy to improve testing in hard-to-reach young adults, provided they are aware of and willing to use oral HIV self-testing (HIVST). This study examined awareness of and willingness to use oral HIVST among 350 high-risk young adults, aged 18–22, living in Kenya’s informal urban settlements. Bivariate and multivariate logistic regressions were used to examine differences in HIVST awareness and willingness by demographic and sexual risk factors. Findings showed that most participants were male (56%) and less than 20 years old (60%). Awareness of oral HIVST was low (19%). However, most participants (75%) were willing to use an oral HIV self-test in the future and ask their sex partner(s) to self-test before having sex (77%). Women (OR = 1.80, 95%CI:1.11, 2.92), older participants (aged 20+) (OR = 2.57, 95% CI:1.48, 4.46), and more educated participants (OR = 2.25, 95%CI:1.36, 3.70) were more willing to use HIVST as compared to men, teen-aged, and less educated participants, respectively. Young adults who reported recent engagement in high-risk sexual behaviors, such as unprotected sex, sex while high or drunk, or sex exchange, were significantly less likely to be willing to use an oral HIV self-test kit (OR = 0.34, 95%CI:0.13,0.86). Those with the highest monthly income (OR = 0.47, 95%CI: 0.25, 0.89) were also less willing to use HIVST. More community- and peer-based efforts are needed to highlight the range of benefits of HIVST (i.e., social, clinical, and structural) to appeal to various youth demographics, in addition to addressing concerns relating to HIVST.

KEYWORDS:

• HIV
• rapid test
• self-test
• young adults
• informal urban settlement
• slum
• respondent driven sampling
• Kenya

Acknowledgments

The authors wish to thank the participants, study staff, interviewers, and community and youth representatives who made this research possible in partnership with the Johns Hopkins Bloomberg School of Public Health, the University of Nairobi College of Health Sciences, Kenyatta National Hospital, and the National Health and Development Organization (NAHEDO) of Nairobi, Kenya. Special thanks to the NAHEDO Study Group (NSG): George Khamati, Janet Rose, Stephen Othieno, Priscah Obar, Zaline Othieno, and Timothy Bogho, all affiliated with NAHEDO, Nairobi, Kenya.

Availability of data and material

The dataset analyzed during the current study is available in the Data. Mendeley repository, https://data.mendeley.com/datasets/xdk2frn44k; doi:10.17632/xdk2 frn44k.1.

Authors’ contributions

LJMW and MM are the co-principal investigators of the study (U.S. and Kenya, respectively). LJMW, MM, and MOM planned and implemented the research. DFC also assisted in planning the research relating to HIVST. LJMW and DFC developed the plan for analysis. BOB cleaned the data and conducted the analysis with assistance from DA. BOB, DA, DFC, and LJMW prepared the first draft of the manuscript. MM and MOM provided additional scientific and technical inputs. All authors contributed to editing the manuscript. All authors have read and approved the final manuscript.

Disclosure statement

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

Additional information

Funding

This research was funded through resources and services provided by the Johns Hopkins University Center for AIDS Research (CFAR), an NIH funded program [grant number P30AI094189]. The last author’s work was supported by the National Institute of Mental Health [grant number K01MH107310, PI: Jennings Mayo-Wilson]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.