Exploring factors that influence the integration of HIVST with HCT using a qualitative comparative cross-over design in KwaZulu-Natal, South Africa

ABSTRACT

The World Health Organization recommends using HIV self-testing (HIVST) to improve HIV testing coverage by integrating self-testing for HIV into public domain primary healthcare (PHC) clinics in areas with a high burden of HIV. However, an understanding of the relationship and interaction between HIVST and the standard HIV counselling and testing (HCT), the primary HIV testing approach within public PHC clinics, is limited. We therefore sought to compare experiences of people seeking an HIV test, specifically, how HIVST can be used to enhance HCT when introduced together. A cross-over study design was used wherein participants were randomly exposed to either HCT followed by HIVST or HIVST followed by HCT. Semi-structured interviews were conducted at the baseline, and after each testing exposure. Forty volunteers were enrolled and 119 interviews were completed. Although a higher preference for HIVST was reported, a symbiotic relationship between HIVST and HCT was identified, where benefits of one testing approach overcame barriers of the other. Introducing HIVST as an additional testing approach with HCT within PHC facilities in South Africa could positively influence HIV testing given their complementary relationship. HIVST and HCT should accommodate HIV testing situations among HIV testing naïve and repeat testing populations.

KEYWORDS:

• HIV
• self-testing
• HCT
• HIV status awareness
• South Africa

Acknowledgements

The research was supported by a scholarship from the University of KwaZulu-Natal. The authors wish to thank CAPRISA, eThekwini and Vulindlela PHC clinics for its support, as well as the participants who contributed to the study. All authors have read and approved the final manuscript. C. H., M. M. and Q. A. K designed the research study and prepared the manuscript. C. H. and P. K. performed the research. C. H. analysed the data with P. K. and S. S.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

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

Mosa Moshabela http://orcid.org/0000-0002-9438-7095