When healthcare providers are supportive, 'I'd rather not test alone': Exploring uptake and acceptability of HIV self-testing for youth in Zimbabwe - A mixed method study

Constancia V Mavodza, Constance R S Mackworth-Young, Tsitsi Bandason, Ethel Dauya, Chido Dziva Chikwari, Mandikudza Tembo, Tsitsi Apollo, Getrude Ncube, Katharina Kranzer, Rashida Abbas Ferrand, Sarah Bernays, Constancia V Mavodza, Constance R S Mackworth-Young, Tsitsi Bandason, Ethel Dauya, Chido Dziva Chikwari, Mandikudza Tembo, Tsitsi Apollo, Getrude Ncube, Katharina Kranzer, Rashida Abbas Ferrand, Sarah Bernays

Abstract

Introduction: In sub-Saharan Africa, less than half of young people know their HIV status. HIV self-testing (HIVST) is a testing strategy with the potential to offer privacy and autonomy. We aimed to understand the uptake and acceptability of different HIV testing options for youth in Harare, Zimbabwe.

Methods: This study was nested within a cluster randomized trial of a youth-friendly community-based integrated HIV and sexual and reproductive health intervention for youth aged 16-24 years. Three HIV testing options were offered: (1) provider-delivered testing; (2) HIVST on site in a private booth without a provider present; and (3) provision of a test kit to test off site. Descriptive statistics and proportions were used to investigate the uptake of HIV testing in a client sample. A focus group discussion (FGD) with intervention providers alongside in-depth interviews, paired interviews and FGDs with a selected sample of youth clients explored uptake and acceptability of the different HIV testing strategies. Thematic analysis was used to analyse the qualitative data.

Results: Between April and June 2019, 951 eligible clients were tested for HIV: 898 (94.4%) chose option 1, 30 (3.25%) chose option 2 and 23 (2.4%) chose option 3. Option 1 clients cited their trust in the service and a desire for immediate counselling, support and guidance from trusted providers as the reasons for their choice. Young people were not confident in their expertise to conduct HIVST. Concerns about limited privacy, confidentiality and lack of support in the event of an HIV-positive result were barriers for off-site HIVST.

Conclusions: In the context of supportive, trusted and youth-friendly providers, youth clients overwhelmingly preferred provider-delivered HIV testing over client-initiated HIVST or HIVST off site. This highlights the importance of listening to youth to improve engagement in testing. While young people want autonomy in choosing when, where and how to test, they do not want to necessarily test on their own. They desire quality in-person counselling, guidance and support, alongside privacy and confidentiality. To increase the appeal of HIVST for youth, greater provision of access to private spaces is required, and accessible pre- and post-test counselling and support may improve uptake.

Trial registration: ClinicalTrials.gov NCT03719521.

Keywords: HIV self-testing; Zimbabwe; decision-making; preferences; sequential explanatory mixed method design; youth.

Conflict of interest statement

None declared.

© 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

References

    1. Ajayi AI, Awopegba OE, Adeagbo OA, Ushie BA. Low coverage of HIV testing among adolescents and young adults in Nigeria: implication for achieving the UNAIDS first 95. PLoS One. 2020;15(5):e0233368.
    1. Sam‐Agudu NA, Folayan MO, Ezeanolue EE. Seeking wider access to HIV testing for adolescents in sub‐Saharan Africa. Pediatr Res. 2016;79(6):838–45.
    1. Somefun OD, Wandera SO, Odimegwu C. Media exposure and HIV testing among youth in Sub‐Saharan Africa: evidence from Demographic and Health Surveys (DHS). SAGE Open. 2019;9(2).):
    1. Asaolu IO, Gunn JK, Center KE, Koss MP, Iwelunmor JI, Ehiri JE. Predictors of HIV testing among youth in Sub‐Saharan Africa: a cross‐sectional study. PLoS One. 2016;11(10):e0164052.
    1. Lee VJ, Tan SC, Earnest A, Seong PS, Tan HH, Leo YS. User acceptability and feasibility of self‐testing with HIV rapid tests. JAIDS J Acquir Immune Defic Syndr. 2007;45(4):449–53.
    1. Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis. J Int AIDS Soc. 2017;20(1):21594.
    1. Krause J, Subklew‐Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self‐testing: a systematic literature review. BMC Public Health. 2013;13(1):735.
    1. van Rooyen H, Tulloch O, Mukoma W, Makusha T, Chepuka L, Knight LC, et al. What are the constraints and opportunities for HIVST scale‐up in Africa? Evidence from Kenya, Malawi and South Africa. J Int AIDS Soc. 2015;18(1):19445.
    1. Stevens DR, Vrana CJ, Dlin RE, Korte JE. A global review of HIV self‐testing: themes and implications. AIDS Behav. 2018;22(2):497–512.
    1. Kumwenda M, Munthali A, Phiri M, Mwale D, Gutteberg T, MacPherson E, et al. Factors shaping initial decision‐making to self‐test amongst cohabiting couples in urban Blantyre, Malawi. AIDS Behav. 2014;18(Suppl 4):S396–404.
    1. WHO . Guidelines on HIV self‐testing and partner notification: supplement to consolidated guidelines on HIV testing services. Geneva: World Health Organization; 2016.
    1. Pettifor A, Stoner M, Pike C, Bekker L‐G. Adolescent lives matter: preventing HIV in adolescents. Curr Opin HIV AIDS. 2018;13(3):265.
    1. Choko AT, MacPherson P, Webb EL, Willey BA, Feasy H, Sambakunsi R, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self‐testing for HIV in Blantyre, Malawi: a community‐based prospective study. PLoS Med. 2015;12(9):e1001873.
    1. WHO . Policy Brief: WHO recommends HIV self‐testing. Geneva: World Health Organization; 2016.
    1. Ritchwood TD, Selin A, Pettifor A, Lippman SA, Gilmore H, Kimaru L, et al. HIV self‐testing: South African young adults’ recommendations for ease of use, test kit contents, accessibility, and supportive resources. BMC Public Health. 2019;19(1):123.
    1. Ivankova NV, Creswell JW, Stick SL. Using mixed‐methods sequential explanatory design: from theory to practice. Field Methods. 2006;18(1):3–20.
    1. Tashakkori A, Teddlie C. Sage handbook of mixed methods in social and behavioral research. SAGE Publications; 2010.
    1. Green J, Thorogood N. Analyzing qualitative data. Qualitative methods for health research. London: Sage Publications; 2004. p.195–228.
    1. Welsh E. Dealing with data: using NVivo in the qualitative data analysis process. Forum qualitative sozialforschung/Forum: qualitative social research; 2002.
    1. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–907.
    1. Kiene SM, Sileo K, Wanyenze RK, Lule H, Bateganya MH, Jasperse J, et al. Barriers to and acceptability of provider‐initiated HIV testing and counselling and adopting HIV‐prevention behaviours in rural Uganda: a qualitative study. J Health Psychol. 2015;20(2):173–87.
    1. Armstrong A, Baggaley R, Ferguson J, Van der Kwaak A, Wolmarans L. The voices, values and preference of adolescents on HIV testing and counselling. Geneva: World Health Organization; 2013.
    1. Rosenberg NE, Bhushan NL, Vansia D, Phanga T, Maseko B, Nthani T, et al. Comparing youth friendly health services to the standard of care through “Girl Power‐Malawi”: a Quasi‐Experimental Cohort Study. J Acquir Immune Defic Syndr. 2018;79(4):458.
    1. Burke V, Nakyanjo N, Ddaaki W, Quinn C, Hutchinson N, Wawer M, et al. HIV self‐testing values and preferences among sex workers, fishermen, and mainland community members in Rakai, Uganda: a qualitative study. PLoS One. 2017;12:e0183280.
    1. Indravudh PP, Sibanda EL, d'Elbée M, Kumwenda MK, Ringwald B, Maringwa G, et al. ‘I will choose when to test, where I want to test’: investigating young people's preferences for HIV self‐testing in Malawi and Zimbabwe. AIDS. 2017;31(Suppl: 3):S203–12.
    1. Doyle KL, Woods SP, Morgan EE, Iudicello JE, Cameron MV, Gilbert PE, et al. Health‐related decision‐making in HIV disease. J Clin Psychol Med Settings. 2016;23(2):135–46.
    1. Kasoka K. Autonomy in HIV testing: a call for a rethink of personal autonomy in the HIV response in sub‐Saharan Africa. Med Health Care Philos. 2020;23(3):519–36.
    1. Tariq S, Hoffman S, Ramjee G, Mantell JE, Phillip JL, Blanchard K, et al. “I did not see a need to get tested before, everything was going well with my health”: a qualitative study of HIV‐testing decision‐making in KwaZulu‐Natal, South Africa. AIDS Care. 2018;30(1):32–9.
    1. Kawuma R, Seeley J, Mupambireyi Z, Cowan F, Bernays S. “Treatment is not yet necessary”: delays in seeking access to HIV treatment in Uganda and Zimbabwe. Afr J AIDS Res. 2018;17(3):217–25.
    1. Dziva Chikwari C, Bernays S, Dringus S, Simms V, Weiss HA, Sibanda E, et al. Addressing the challenges and relational aspects of index‐linked HIV testing for children and adolescents: insights from the B‐GAP study in Zimbabwe. Implement Sci Commun. 2020;1(1):99.

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