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Introducing HIV self-testing to rural communities in Malawi: cognitive interviewing may alert implementers to the need for additional support beyond that provided by manufacturer


Author
Indravudh et al.

Publication year
2016

Country

Type of approach
Community-based

Type of assistance
Directly assisted

Specimen
Oral-fluid

Study population
Mixed: Young people and general population: adults over 16 years

Study design
Feasibility/acceptability

Sample size
301

UNAIDS HIV prevalence (2017)
9.1 [8.4 - 9.9]

Methodology
Oral fluid-based HIV self-test kits were procured with pictorial instructions-for-use and text in English and Chichewa (Malawian language). Ease-of-use was assessed by 20 cognitive interviews of literate adults (16 years) attending rural HIV testing services in Blantyre, Malawi. Participants were provided with packaged kits containing instructions-for-use but no other assistance. A standardised questionnaire and observation record was administered during self-testing. Feasibility was then evaluated in two villages where 281 participants were randomly-selected from households and community peer groups (age 16 years or older, not taking antiretrovirals). Baseline and exit questionnaires were administered to the feasibility group. HIVST followed a brief demonstration of contents and kit usage. HIVST results were compared to a reference standard (3 rapid kits in parallel, by a trained professional).

Summary of findings
20 cognitive interviews were conducted, in which many challenges arose including participants having difficulty opening the self-test packaging, misinterpretation of translated phrases (two pouches, test stand) and imagery. Abstract symbolisation (e.g. knife/fork for eating and traffic signal were not was not well-recognised by participants. Although 18/20 participants completed the HIV self-test, these difficulties greatly affected timeliness and confidence in validity. In contrast, all 281 feasibility participants (80.0% literate) completed an HIV self-test following a standardised demonstration. Self-read results agreed with reference for 11/12 HIV-positive participants (sensitivity 91.70%, 95%CI 61.5%-99.8%) and 268/269 HIV-negative participants (specificity 99.60%, 95%CI 97.9%-100%).

Acceptability
0.81

Acceptability details
81.0% of randomly selected adults and all peer group members opted to self-test. Perceived ease and satisfaction were high, with 100% recommending HIVST to friends/family.

Willingness to pay
n/a

Willingness to pay details
n/a

Sensitivity
0.917

Specificity
0.996

Concordance
n/a

HIV positivity
4.3% (12/281)

Accuracy details
n/a

Social harm
n/a

Linkage to prevention, care and treatment
n/a


Study status
Completed

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