Search HIVST

Providing user support for HIV self-testing beyond instructions-for-use in Malawi


Author
Indravudh et al.

Publication year
2017

Country

Type of approach
Community-based

Type of assistance
Both

Specimen
Oral-fluid

Study population
General population: General population

Study design
Feasibility/acceptability

Sample size
360

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

Methodology
Cross-sectional study to assess feasibility, acceptability and accuracy of semi-supervised (directly-assisted) HIVST. Two studies were conducted: (1) cognitive interviews with literate adults, attending voluntary counseling and testing in rural and urban health facilities (n=20). Respondents were provided the HIVST kits with no other assistance and administered a topic guide (unassisted). (2) Feasibility study, with participants age 16 years or older, of randomly selected households and purposively selected peer groups from two rural villages (n=340). Participants could choose from self-testing, standard testing or no testing. Self-testers received a demonstration on kit content and usage. HIVST results were then compared to a reference standard (2 parallel rapid blood-based tests by trained professionals). Study period: May to July 2016

Summary of findings
In the cognitive interviews all participants completed the self-test and accurately interpreted their results, though there were difficulties affecting timeliness and confidence in validity. In the feasibility study participants were able to self-test accurately with just the instructions-for-use. Acceptability was high, 85.6% (291/340) accepted to self-test, 3.8% (13/340) tested through standard methods, and 10.6% (36/340) declined to test.

Acceptability
0.856

Acceptability details
85.6% (291/340) accepted to self-tested

Willingness to pay
n/a

Willingness to pay details
n/a

Sensitivity
0.929

Specificity
0.996

Concordance
n/a

HIV positivity
4.1% (14/340)

Accuracy details
Sensitivity 92.9%, 95%CI 66.1%-99.8%, specificity 99.60%, 95%CI 98%-100%. Most common error: reading results before specified time (5/291).

Social harm
n/a

Linkage to prevention, care and treatment
Linkage into care was not investigated in this study but all HIVST results were compared to reference standard testing (2 parallel rapid blood-based tests by trained professionals).


Other studies related to this project
A cluster randomised trial of community-led distribution of HIV self-tests in rural Malawi (HIV Self-Testing Africa)
Discordance, disclosure and normative gender roles: a triad of barrier to couples HIVST provided through a community-based approach in urban Blantyre, Malawi
HIV self-testing in Zambia: User ability to follow the manufacturer's instructions-for-use
Optimising uptake of HIV testing among young people: a mixed-methods study on HIV self-testing preferences in Zimbabwe and Malawi
Prevalence of testing and preference for self-testing in Malawi and Zambia: baseline data from the STAR (HIV self-testing in Africa) project
Increasing knowledge of HIV status among men: a cluster-randomised trial of community-based distribution of oral HIV self-test kits nested in four HPTN 071 communities in Zambia
I will choose when to test, where I want to test: investigating young people's preferences for HIV self-testing in Malawi and Zimbabwe
Perceptions of introducing HIVST and peer-led delivery model amongst female sex workers in rural and urban districts in southern Malawi
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
Economic costs and health-related quality of life outcomes of HIV treatment after self- and facility-based HIV testing in a cluster randomized trial
Understanding coercion in the context of semi-supervised HIV self-testing in urban Blantyre, Malawi
Acceptability of woman-delivered HIVST to the male partner: a qualitative study of ANC clinic-linked participants in Blantyre, Malawi
Factors shaping initial decision-making to self-test amongst cohabiting couples in urban Blantyre, Malawi
The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi
Community-based distribution of oral HIV self-testing kits
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
Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counseling in Blantyre, Malawi
Effect of optional home initiation of HIV care following HIV self-testing on antiretroviral therapy initiation among adults in Malawi: a randomized clinical trial.
Stigmatising attitudes among people offered home-based HIV testing and counseling in Blantyre, Malawi: construction and analysis of a stigma scale
The influence of masculinity on HIVST community intervention: a qualitative evaluation of empirical evidence from Blantyre, Malawi
Acceptability of woman-delivered HIV self-testing to the male partner, and additional interventions: a qualitative study of antenatal care participants in Malawi
Is OraQuick HIV-self-testing valid among intended users? Analysis from a clinical performance study in Lusaka, Zambia
A trial investigating multiple potential interventions for increasing uptake of HIV testing and linkage into care for male partners of pregnant women attending antenatal clinic through HIV self-testing