Acceptability and usability evaluation of finger-stick whole blood HIV self-test as an HIV screening tool adapted to the general public in the Central African Republic
Gresenguet et al.
Type of approach
Type of assistance
Mixed: Adults, men who have sex with men, and female sex workers
UNAIDS HIV prevalence (2017)
Both an acceptability study and a usability evaluation were conducted. The acceptability study was conducted among university students, including men who have sex with men and female sex workers. Participants were recruited from 13 secondary schools in Bangui and invited to complete a questionnaire about their HIV testing history and willingness to HIV self-test. The usability evaluation was conducted between June and July 2016. In this cross-sectional study, participants were recruited from sites where HIV testing and counselling is offered, including two major hospitals. Participants included patients, visitors or relatives at the clinic sites and healthcare workers. Participants completed a questionnaire on their interpretation of the HIV self-testing instructions and an evaluation concerning interpretation of HIV self-test results. Participants were also observed using the HIV self-test (whole blood/finger-stick) by a researcher. Participants had access to written self-testing instructions and could simulate calling a help hotline for testing assistance, but were not directly-assisted by the observing researcher.
Summary of findings
In total, 3,484 participants completed the acceptability survey. The majority of participants had heard of HIVST (77-98%, n=n/a), were willing to use HIVST if it was available (69-97%, n=n/a), thought that post-testing counselling is necessary to HIVST (74-95%, n=n/a) and were willing to test their partner using HIVST kits (52-98%, n=n/a). Pre-test counselling before HIVST was generally considered unnecessary. Finally, some groups were willing to buy HIVST, if available, mainly male students (77%, n=644), men who have sex with men (92%, n=364) and female sex workers (94%, n=458), whereas others groups, including female students (32%, n=302) and female sex workers from poorer neighborhoods (21%, n=83), were not. Three hundred participants were recruited for the usability evaluation. In the usability evaluation, 91% (n=273) of participants correctly understood the instructions for use. Age of users was associated with understanding the testing instructions: 78.5% (n=113) aged 18 to 29 years interpreted instructions correctly, 89.4% (n=67) aged 30 to 39 years and only 60.4% (n=49) aged 40+ years (p < 0.01). 83.3% (n=250) of participants found the instructions easy to understand and 71.3% (n=214) had a favorable opinion for having instructions in the vernacular language. 96.9% (n=3782) of test results were correctly interpreted in the questionnaire. Having lower education was associated with incorrectly reading positive or invalid test results. Overall, 91.6% (n=275) of participants correctly used the HIV self-test and succeeded in obtaining an interpretable result. The successful performing of HIV self-testing was less frequent in lay users (78.2%, n=n/a) than health care workers (91.2%, n=n/a) (p < 0.01). In total, 23% (n=71) of participants had asked for oral assistance, primarily during the steps for using the lancing. Need of oral assistance during self-testing was associated with poor understanding of instructions.
69-97% (n=n/a) of participants were willing to use HIVST if it was available and 52-98% (n=n/a) were willing to test their partners using HIVST kits.
Willingness to pay
Willingness to pay details
Some groups were willing to buy HIVST, if available, mainly male students (77%, n=644), men who have sex with men (92%, n=364) and female sex workers (94%, n=458), whereas others groups, including female students (32%, n=302) and female sex workers from poorer neighborhoods (21%, n=83), were not.
During the questionnaire for interpreting self-test results, the Cohens K coefficient between the results of reading by participants and the expected results was 0.94, demonstrating excellent concordance according to Landis and Kochs rank.
Linkage to prevention, care and treatment