Research Article: HIV Self-Testing in Lusaka Province, Zambia: Acceptability, Comprehension of Testing Instructions, and Individual Preferences for Self-Test Kit Distribution in a Population-Based Sample of Adolescents and Adults

Date Published: March 01, 2018

Publisher: Mary Ann Liebert, Inc.

Author(s): Arianna Zanolini, Jenala Chipungu, Michael J. Vinikoor, Samuel Bosomprah, Mazuba Mafwenko, Charles B. Holmes, Harsha Thirumurthy.


We assessed attitudes and preferences toward HIV self-testing (HIVST) among Zambian adolescents and adults. We conducted a population-based survey of individuals aged 16–49 years old in Lusaka Province, Zambia. HIVST was shown to participants through a short video on oral fluid-based self-testing. In addition to demographics, HIV risk perceptions, and HIV testing history, we assessed participants’ acceptability and concerns regarding HIVST. Using a discrete choice experiment, we investigated preferences for the location of self-test pickup, availability of counseling, and cost. After reviewing an instructional sheet or an additional video, we assessed participants’ understanding of self-test performance. Among 1617 participants, 647 (40.0%) were male, 269 (16.6%) were adolescents and 754 (46.6%) were nontesters (i.e., no HIV test in the past 12 months). After viewing the video, 1392 (86.0%) reported that HIVST would make them more likely to test and while 35.0% reported some concerns with HIVST, only 2% had serious concerns. Participants strongly preferred HIVST over finger prick testing as well as having counseling and reported willingness to pay out-of-pocket (US$3.5 for testers and US$5.5 for nontesters). Viewing an HIVST demonstration video did not improve participant understanding of self-test usage procedures compared to an instructional sheet alone, but it increased confidence in the ability to self-test. In conclusion, HIVST was highly acceptable and desirable, especially among those not accessing existing HIV testing services. Participants expressed a strong preference for counseling and a willingness to pay for test kits. These data can guide piloting and scaling-up of HIVST in Zambia and elsewhere in Africa.

Partial Text

Low uptake of HIV testing services in sub-Saharan Africa (SSA) is among the main barriers to achieving the 90-90-90 targets established by UNAIDS1 and to realizing the promise of HIV treatment as prevention.2 About 50% of HIV-positive persons in SSA are unaware of their HIV status, and awareness is particularly low among men.1 While approaches that bring testing services into communities may overcome standard barriers to clinic-based testing,3,4 there remains a need for additional testing approaches that can be accessed by otherwise hard-to-reach segments of the population and that can facilitate more frequent testing.4,5

Among 1912 houses randomly selected for the survey in Lusaka Province, 1617 adolescents and adults participated (representing 84.6% of households). During recruitment, 229 selected houses were empty, 49 had an adult who could not be reached, and 17 had an adult who declined participation. We interviewed an average of 95 participants per CSA and 77% of the participants resided in urban areas.

In a representative survey of adolescents and adults living in Lusaka Province, Zambia, HIVST was found to be highly acceptable and participants expressed relatively few concerns regarding the introduction of HIVST. Importantly, those who had not recently tested reported strong willingness to learn their HIV status through a self-test. The use of tablets was both highly feasible and facilitated communication around HIVST even though actual self-tests were not available in Zambia at the time of the survey. Participants also expressed a strong preference for counseling to be made available with HIVST as well as a willingness to pay US$3–5 out-of-pocket for test kits. Together these data can guide piloting and scaling-up of HIVST in Zambia and the region. Strengths of the study include its relatively large sample size and representativeness of the largest Province in Zambia, which enhances external validity of the results. Participant characteristics were similar to those from the recent Zambia Demographic and Health survey.22 By utilizing a DCE, the study also enhances understanding of individuals’ preferences for HIVST without having provided self-tests.




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