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Dr
Grace McHugh

Zimbabwe

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Profile EDCTP Fellowship 1

Project Title

Feasibility and acceptability of HIV self-testing in adolescents and young people

EDCTP Project

TMA2017CDF-1923

EDCTP Program

EDCTP2

EDCTP Project Call

Career Development Fellowship (CDF)

Project Objectives

1. To assess the uptake of HIV-self testing among AYP in an urban young population in Harare, Zimbabwe 2. To assess the acceptability of HIV self-testing using OMT kits in this age group and determine their proficiency in using this technology. 3. To determine the prevalence of HIV and assess linkage to care in AYP i.e. either HIV prevention services or HIV care and treatment services depending on results of OMT test. 4. To conduct a process evaluation of the intervention’s implementation, mechanisms of impact and local context to inform the components required for sustainability and scalability.

Study Design

Observational study

Project Summary

Despite new HIV infections declining for the past decade, youth are disproportionately affected by HIV. In Sub Saharan Africa (SSA), where adolescent girls and young women aged 15-24 years of age make up 10% of the population, they accounted for 1 in 4 of all new HIV infections in 2019 across all age groups. HIV self-testing (HIVST) is a method of HIV testing that may allow more people gain knowledge of their HIV status and access both treatment and prevention services. Attending for facility-based, provider-led HIV testing is a recognised barrier for youth in taking up HIV testing services. Youth fear judgement, stigma and discrimination from health care providers which in turn leads to a reluctance to seek testing. The results of distribution of HIV self-testing kits to youth aged 16-24 years at selected third level institutions across Zimbabwe assist in determining the feasibility of HIVST distribution campaigns on campus. This study reports on the uptake of HIV testing, HIV prevalence of those who reported their test results and subsequent linkage to care for those who had a reactive test. In addition, the processes of offering HIV self-testing on campus are explored through qualitative data collection and analysis.

Host Organisation

Department Institution Country
Biomedical Research and Training Institute (BRTI) Biomedical Research and Training Institute (BRTI) ZW

Results & Outcomes

Over a period of 149 days, 6,296 youth took a HIV self-test. Overall, 4138 (66%) had taken a HIV test previously, median number of times of having taken a test in the past was 2 (IQR 1-3). Of the males who tested, 715 (31%) were first time testers, of females, 1443 (36%) were first time testers. 2967 (43%) had previously heard of being able to test oneself for HIV. In total, 3,733 (59%) opted to test off-site, the remaining testing, onsite, in a private booth, unassisted. A total of 3,673 (58%) fed back their results, 2,356 of those who tested onsite and 1,317 who had tested offsite. Overall, 46 (1%) of those who responded had a reactive result, 2 an indeterminate result and 3625 (99%) were negative. Of the reactive tests, 23 of these results were reported in the period prior to offering confirmatory testing at the distribution site. None of the 23 had attended a facility for confirmatory testing prior to introduction in onsite confirmatory testing. After the introduction of confirmatory testing of the 23 with reactive tests, 18 (78%) had confirmatory testing onsite, the other five youths refused confirmatory testing. The vast majority of AYP positively endorsed campus-based delivery of HIVST (19/26 IDI participants). They cited a perceived increase in autonomy, convenience, and social acceptability as attractive elements of this distribution modality. Participants who tested on-site expressed that young adult lay counsellor led delivery of HIVST on campus generated an increased sense of social acceptability around HIV testing. Testing with their age cohort in a familiar environment appeared to reduce perceived stigma typically associated with testing uptake in traditional venues accessed or staffed by adults. Participant preferences for campus-based HIVST revealed competing desires for complete autonomy while testing, and readily available access to post-test counselling services in the event of a reactive test result. Participants raised concerns about adequate a