HIV self-testing as part of a differentiated HIV testing approach: exploring urban and rural adult experiences from KwaZulu-Natal, South Africa using a cross-over study design

Background Suboptimal HIV testing rates through available testing approaches such as HIV counselling and testing have directed research efforts toward recognizing the potential of HIV self-testing as an additional testing method. However, HIV self-testing is not readily available within HIV testing facilities and data on how HIV self-testing and HIV counselling and testing will co-exist within HIV testing facilities is limited. Therefore, this study sought to fill this knowledge gap. Methods Forty consenting adults were exposed to HIV counselling and testing and HIV self-testing using a cross-over study design between February 2016 and February 2017 resulting in 80 (20,20) interviews. Participants were randomly exposed to HIV counselling and testing first, followed by self-testing, or HIV self-testing first, followed by counselling and testing. In-depth interviews were conducted at baseline, and after each testing exposure, using a semi-structured interview guide. Interviews were transcribed and translated prior to doing the framework analysis. Results Support through counselling played a central role in the HIV testing process for some participants who desired support or were not confident to perform unsupervised HIV self-testing. The complementary relationship between HIV self-testing and HIV counselling and testing requires a combination of benefits such as availability of counselling, confidence, convenience and confidentiality (4 Cs) derived from HIV self-testing and HIV counselling and testing. Implementation of the 4 Cs will depend on the availability of unsupervised HIV self-testing and/or supervised self-testing with support from HIV counselling and testing. Conclusions As treatment and prevention efforts expand, the reasons for and frequency of testing is changing and there is a need to develop differentiated models for providing HIV testing services to meet client’s needs. HIV self-testing is an important addition to enhance HIV testing efforts and should be offered in combination with HCT

Repeat HIV testing practices in the era of HIV self-testing among adults in KwaZulu-Natal, South Africa.

CAPRISA, 2019.Abstract available in PDF

A qualitative study of patient motivation to adhere to combination antiretroviral therapy in South Africa.

CAPRISA, 2015.Abstract available in pdf

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

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