Acceptability of HIV self-testing among men and women in KwaZulu-Natal, South Africa

ABSTRACT

Successful implementation of Universal Test and Treat as a strategy to achieve the 90-90-90 target requires higher HIV testing rates. Currently, uptake of HIV testing is not optimal which has directed research initiatives towards identification of additional HIV testing methods. HIV self-testing (HIVST) has received growing attention as a complementary testing approach as it overcomes barriers that are commonly associated with current HIV testing methods. In sub-Saharan Africa, acceptability rates showed a gendered pattern of men benefitting more than women, with limited evidence to explain this difference. This study assessed whether men or women in KwaZulu-Natal displayed a higher acceptance of HIVST and also explored factors that influenced and motivated their acceptability. Participants were recruited through purposive sampling at two clinical research sites to participate and underwent qualitative assessments. The outcomes from focus group discussions coupled with findings from a scoping review informed the design and data collection instruments for in-depth interviews. A randomised cross-over study design exposed participants to HIV counselling and testing and HIVST, accompanied by before (baseline) and after in-depth interviews. HIVST was acceptable among most participants with acceptability higher in women. Men preferred HIVST due to convenience and efficiency, whilst women favoured HIVST due to its potential to provide autonomy and empowerment. Also, lack of HIV counselling and managing a positive HIV result as well as linkage to care were raised as deterrents of HIVST. As HIVST was acceptable by most participants, future research efforts should be directed towards evaluating the feasibility of its introduction into the public health sector.

KEYWORDS:

• HIV self-testing
• South Africa
• HIV testing
• universal test and treat
• first 90
• HCT

Acknowledgements

This study was conducted at Centre for the AIDS Programme of Research in South Africa (CAPRISA) Clinical Research Sites in Durban and Vulindlela. The author’s wish to thank the CAPRISA for its support and participants who contributed to the study and Ms ZQ Simelane for her assistance with the data collection.

Disclosure statement

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

ORCID

Charlene Harichund http://orcid.org/0000-0003-4641-1924

Additional information

Funding

The research was supported by a scholarship from the University of KwaZulu-Natal.