Acceptability and perceptions of HIV oral self-testing across settings: A comparative qualitative study among Dominican and Tanzanian female sex workers

ABSTRACT

Rapid oral HIV self-tests (HIVST) have potential to increase the proportion of people who know their HIV status, especially among stigmatised populations. This study was embedded in two cohorts of female sex workers (FSW) in the Dominican Republic (DR) and Tanzania. Qualitative interviews with 40 FSW were conducted to explore perceived acceptability of HIVST. Interviews were analysed using inductive and deductive thematic coding. Emergent themes were organised by socio-ecological framework levels. FSW in both settings responded positively to the ease of use of HIVST but questioned test accuracy due to the use of saliva rather than blood. FSW in the DR had a more cautious response, while women in Tanzania had favourable perceptions expressing eagerness to use it. At the individual level, themes shaping participants’ interest included autonomy, HIV risk perception, and emotional well-being for those with reactive test results, and self-efficacy. At the interpersonal level, privacy, confidentiality, sex work and HIV stigma and social support were salient. Structural level themes focused on health systems including linkages to HIV treatment, provider roles, and access (cost, travel, distribution). Understanding FSW’s perceptions and acceptability of HIVST is essential to its integration into health systems and programmes using a community-driven approach.

KEYWORDS:

• HIV
• self-testing
• female sex workers
• Dominican Republic
• Tanzania

Acknowledgements

We would like to thank the study participants and research teams from the Dominican Republic and Tanzania for their time, dedication, and commitment to this work.

Disclosure statement

S.W. Beckham receives funding from ViiV Healthcare. No other potential conflict of interest was reported by the other author(s).

Data availability statement

Data cannot be shared publicly because of potentially sensitive information from a vulnerable population. Data are available by contacting the IRB of the Johns Hopkins Bloomberg School of Public Health for researchers who meet the criteria for access to confidential data at [email protected].

Additional information

Funding

This work was supported by the National Institute of Mental Health grants R01MH110158 and R01MH104033 PI Kerrigan and K01MH114715 PI Beckham); the Johns Hopkins University Center for AIDS Research [grant number P30AI094189]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.