Is Kenya ready to scale up HIV self testing? A qualitative study among lay (untrained) users of HIV self-testing prototypes Kababu M, Muturi N, Peck R, Lim J, Taegtmeyer M and Mukoma W U.O.N collaborative meeting January 2015 1
Rationale • The HIV self-test development process requires to take into account the needs and limitations of the user. • Usability testing is an important requirement in the test development process. This will help identify potential use related problems which can be addressed early in the test design and development process. 2
Study objectives • To explore constraints and opportunities for scale up of HIV Self testing in Kenya • To identify characteristics of the potential target population for self testing • To evaluate ease of use and acceptability of selected late-stage prototype HIV rapid tests among lay users. 3
Methodology • An exploratory qualitative study. Conducted in 2 phases: a) Phase 1: Key informant interviews • Sample size:19 • Purposive sampling from different areas of expertise: Government, Procurement/Distribution/supply chain, Advocates for community and vulnerable groups, PLHA, academic researchers, health care providers • Study site: Nairobi • Study period: July and August 2013 • Interviews transcribed verbatim and analyzed using NVIVO 10 4
Methodology…cont’d b) Phase 2: Usability Phase – Lay users Purposive sampling: 25 male, 25 female. Data collection: observation of participants conducting a HIV self test using a prototype and IDI Study sites : Hurlingham VCT, Sokoni VCT, Nairobi Deaf VCT; and Highway Resource Community Centre (Mlolongo) Study period: August to September 2013 Interviews transcribed verbatim and analyzed using NVIVO 10 5
Key Findings: Phase 1 • Mixed reactions on the country’s readiness to scale up HIV self testing. ‘ So in terms of being ready I think we are … I think we are ready to introduce self-testing and put it in a structured form…’( Policy 001) ‘ The country may not be that ready.’(Acad002) Reasons for scale up: Need to increase the HIV testing coverage; • self testing would supplement the current strategies ‘ It is only by introducing a different approach of testing that we may actually know the actual or near to the actual number of people who are actually infected with the HIV virus.’ (Acad002) Reasons against: No clear policy on HIV self testing, MOH has not • approved a self test kit in the country yet, potential for abuse of the kits ‘… for us to implement it we need to have a clear policy…we are not ready because we don’t have any system of introducing self- testing we don’t have any policy on that… (Policy002) 6
Key Findings: Phase 1…cont’d • Suggested target populations for self testing: Key populations, working class, men, couples, the youth ‘ If we have something like a self-test and the people, first of all what I advocate for strongly is the issue of couples testing together... Most of these that you call MARPS (key populations) they will really need it… (Actv001) • Challenges of scale up: Linkage to care, access to counselling, data reporting and monitoring, potential for abuse • Cost of the self test kits should be affordable; government and other implementing partners can play a role ‘The cheapest that people can afford, a cheap thing cannot be 500, it can be about 100 not more than KES 100.’ (Act004) • Preferred test characteristics: small, easy to use, stable, sensitivity and specificity 7
Key Findings: Phase 2 There was great enthusiasm among lay users on the idea of self- testing with most respondents reporting that they would recommend it to others. Reasons for: Less time consuming Important for those who cannot visit a VCT Privacy Perceived challenges Linkage to care Potential for abuse 8
Key Findings: Phase 2 • Majority of the respondents were able to use the self test prototypes with minimal assistance. However, • Incorrect use of the oral swab (swabbing using the wrong side)/putting blood in the wrong hole was observed • study participants reported a fear in pricking themselves • challenges in using the lancets due to their uniqueness and lack of clarity on the instructions on their use • concerns on determining the correct amount of blood to conduct the test 9
Key Findings: Phase 2…cont’d • Preferred location to conduct a self test: at home (private and comfortable) • Where to seek help incase of difficulties: health facility; use of a help line; from where the test kits are obtained • Options on disposal: burning, throwing in a latrine/rubbish bins. • Preferred cost of kits: should not exceed 100 KES/free of charge • Where to obtain the kits: Chemists; health facilities (free) • Most were willing for a confirmatory test if the self-test results were HIV positive and in a health facility especially 10
Key Findings: Phase 2…cont’d Preferred test characteristics • Test kit package: small in size with few components • Test kit instructions: Clear simple language (English and Swahili) with clear pictures • Test procedure: should be short and precise • Preference for oral over the blood tests due to ease of sample collection 11
Key Findings: Phase 2…cont’d Preferred test characteristics • Result panel: color of the test line and control line should be different • Time to results: neither short nor long; between 5 and 20min • Helpline/ phone contact for inquiries 12
Conclusion and recommendations • Majority of the key informants were optimistic about the concept of HIV self-testing in the country • HIVST would increase HTC coverage and improve uptake of HIV testing among the identified segments of the population • Use of self test kits by untrained users is feasible, however their preferences on the test characteristics should be taken into account • Perceived challenges such as linkage to support services and potential for abuse should be addressed • More research required to inform policy on the most cost effective method to scale up HIVST • Need for clear guidelines on the most suitable test kit and referral service for post self-testing in the country. 13
Thank you!!! 14
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