Peer Reviewed Article on Hiv Testing in Africa
AIDS Behav. Author manuscript; available in PMC 2019 Feb 1.
Published in final edited form equally:
PMCID: PMC5764831
NIHMSID: NIHMS892086
Acceptability of HIV Self-testing in sub-Saharan Africa: Scoping study
C Harichund
1Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
Thou Moshabela
2Department of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Southward Africa
threeAfrica heart for Population Health, Mtubatuba, Southward Africa
Abstract
Several HIV testing models have been implemented in sub-Saharan Africa (SSA) to improve access to HIV testing, just uptake remains poor. HIV Cocky-Testing (HIVST) is at present available, and may serve to overcome barriers of electric current testing models which include stigma, discrimination and non-confidential testing environments. A scoping study was conducted to provide an overview of the current literature in SSA, as well as identify time to come enquiry needs to calibration-up HIVST and increase HIV testing uptake. The outcome of the review indicated only 11 reported studies to appointment, showing variable acceptability (22.3% – 94%) of HIVST, with acceptability of HIVST college among men than women in SSA. Nosotros conclude that research around HIVST in SSA is still in its infancy, and further implementation enquiry and interventions are required to improve acceptability of HIVST among various study populations, failing which policy adoption and scale-up may exist hindered.
Keywords: HIV, Self-testing, Admission, Acceptability, sub-Saharan Africa
INTRODUCTION
Despite concerted efforts in engaging community members to get tested and know their HIV status, uptake of HIV testing has not been optimal globally (ane). Lack of HIV sensation is a rate limiting step for anti-retroviral therapy (Fine art) initiation, and will naturally hinder success of global initiatives intended to eliminate HIV by 2030 (i, 2). The United nations Programme on HIV/AIDS (UNAIDS) has set an aggressive 90-xc-xc goal to help end the AIDS epidemic, through which ninety% of people living with HIV should know their HIV status in order to let for successful subsequent handling initiation and viral suppression (2). As a upshot, researchers are investigating new approaches to HIV testing that would increase the uptake, and in return, lead to early on HIV diagnosis and treatment initiation, equally well as prevention options for people who test HIV negative (3–5). A newer approach to HIV testing, HIV Self-Testing (HIVST), has received global recognition as an alternating method to HIV testing. Growing evidence suggests that HIVST will likely serve to overcome several persisting barriers associated with current HIV testing models (3, 6). Barriers such equally HIV-related stigma and bigotry, poor HIV testing facilities, excessive travel costs, inaccessible testing for hard-to-achieve populations and lack of privacy and confidentiality seem to explain poor uptake of HIV testing associated with current HIV testing models, and have therefore created a niche for the adoption of HIVST. (3, half-dozen–8).
Globally, there is stiff evidence to back up the potential of HIVST to access hard-to-attain study populations, merely the acceptability levels of HIVST amidst these key populations has been found to vary widely in both developed and developing countries (6, 9–12). Studies have reported acceptability of HIVST ranging between 20.3% and 95% collectively among men-who-take-sex-with-men (MSM) (x, 13–19), female sexual activity workers (xvi), and transgender women (xix), merely also amidst men and women targeted by gender (11, 20, 21). Globally, inquiry bear witness around differences in acceptability of HIVST betwixt men and women is limited. Much of the HIVST research foci among these target groups have been directed toward issues inclusive of regulatory, policy and ethics, (9, 10, 22, 23), cost and distribution of HIVST kits (9), linkage to intendance (24, 25), and feasibility of implementation (18, 26). Whilst global HIVST research efforts are directing innovative inquiry towards key populations that are hard-to-reach, such breakthroughs are likewise much needed in sub-Saharan Africa (SSA), where targeted populations should include the full general population in addition to primal populations. However, very petty evidence for the employ of HIVST exists in SSA, and adoption of this innovation is lagging behind many developed and developing countries. According to the UNAIDS technical report, bear witness effectually acceptability and factors affecting policy development is limited in SSA, thus preventing scale-up of HIVST (27).
In SSA, voluntary counselling and testing (VCT), and its variations in blueprint, is the most widely recommended model of HIV testing, where testing may be initiated by the patient or health worker. However, reported disadvantages of the VCT model include stigma and discrimination when presenting at HIV testing facilities to examination (28), staff exhaustion at healthcare centres (28), disability to attain target populations for HIV testing (29, 30), high costs associated with implementing testing method (30), involuntary HIV status disclosure and possible adverse social impacts (28, 31). In lite of the imperative to expand HIV testing uptake, frequency and awareness, new testing strategies such every bit HIVST volition become of import to consider for the general and key populations in SSA, where the burden of HIV remains the highest in the earth (4). However, the current body of evidence on HIVST announced to be disproportionately lower in SSA given the burden, and the adoption of HIVST is but a recent development. We therefore sought to synthesize the bear witness base on the growing adoption of HIVST in SSA using a scoping study methodology, and then as to profile the target populations and their acceptability rates of HIVST. We further aimed to map and locate the electric current literature on HIVST within SSA in the broader context of the global evidence base, so as to place gaps to exist potentially addressed in future research, too as related policy implications.
METHODS
The Arksey and O'Malley scoping study methodology (32) was used for this review. Due to the exploratory nature of our review, and the intent to "map" the existing enquiry and look for recurring themes within the literature, a scoping review methodology was the almost advisable methodological approach (33–35). V master phases are followed in scoping reviews: ane) identifying the inquiry question, 2) identifying relevant studies, 3) written report selection, 4) charting the data, and v) collating, summarizing and reporting the results. Scoping review methodology is similar to systematic reviews on the basis of rigorous literature techniques, merely differ in that the criteria for inclusion are not based on quality of the study designs, but on relevance of the report to the question. As a result, studies with mixed designs can be reviewed, including both qualitative and quantitative studies. All data from the included studies are charted, emerging themes are identified and gaps are highlighted. Due to the broad inclusion criteria in scoping reviews when compared to systematic reviews, scoping studies tend to include a large body of published enquiry, and identified gaps tin help researchers guide future research.
Identifying the research question
Arksey and O'Malley (32) recommended a broad and inclusive approach to setting enquiry questions in order to generate breath of coverage in the literature search procedure. Therefore, the research question for this scoping written report was: what is known from existing literature about acceptability of HIV self-testing in SSA? The post-obit questions were included to guide the master enquiry question: one) what is known in the literature? 2) what are the enquiry gaps? and 3) what are the future needs?
Identifying relevant studies
According to Arksey and O'Malley, several literature sources should exist reviewed to provide a broad latitude of coverage of the available literature (32). For this scoping review, English electronic academic databases were reviewed, which included: PubMed, Science Direct, Web of Science, African Journals Online and African Medicus Index. In addition, local and international policies on HIV self-testing were reviewed. Key words used in the search were "HIV"; "Self-testing"; "Testing methods" and "Acceptability". Two full searches were conducted in all electronic bookish databases from August 2015 to January 2017. Four stages of exclusion or inclusion were applied following effect of search results: ane) Year (articles were excluded if pre year 1990), 2) Championship (if title was irrelevant and then article was excluded), 3) Abstruse (if abstract was irrelevant, article was excluded), and four) Article (if irrelevant, article was excluded).
Study selection
To ensure standardized study selection that was relevant to the research question, the process was guided by the following inclusion criteria: 1) Articles published from the year 1990 onwards, ii) Only articles published in English language, 3) Qualitative and Quantitative research methods and iv) Studies from SSA. Qualitative and quantitative research methods were included to allow for a broader range of studies on the footing of their relevance, and in keeping with scoping review methodology. Since scoping reviews are exploratory by pattern, results from all studies in SSA on the topic were included. Articles related to dwelling house-based self-testing were included, but other home-based testing were excluded from written report selection process when implemented by a healthcare worker or lay counsellor. HIVST was specifically defined, "every bit a process past which an individual performs a rapid diagnostic HIV test and interprets the results themselves".
Charting the data
Information extraction from articles that met the inclusion criteria was conducted in accordance with recommendations past Arksey and O'Malley (32). Charting involved synthesising and interpreting data according to fundamental issues and themes. A data extraction tool was developed, using the program Excel, to ensure relevant and efficient data extraction of information related to HIVST in SSA. Charting of data involved having to enter data into the Excel spreadsheets for each selected article, and ensuring data captured is comparable between included articles.
Collating, summarizing and reporting the results
Levac et al., (2010) (36) recommended an approach to stage 5 of the scoping review that includes three steps (analysing the data, reporting results and applying meaning to the results) to increment consistency in reporting of results. Subsequently collation of data, summaries were generated and combined for reporting purposes. Research gaps were identified based on recommendations from authors, key findings, gaps in charts and lack of evident enquiry from the chart.
RESULTS
A total of 551 relevant report titles, as shown in Effigy 1, met the eligibility criteria for the scoping review. Further screening of the titles, resulted in exclusion of 350 studies which were duplicates retrieved between databases. A further 121 studies were excluded later on abstract review found content to be irrelevant to this scoping review. Review of full articles resulted in exclusion of 69 studies conducted outside of SSA. Ultimately, a total of eleven articles on HIVST in SSA were included for assay in this review, presented in Table I. All the same, only 9 of 11 studies reported specifically on acceptability in general of HIVST. Quantitative assessment was method of choice for most studies, used in eight of the studies. However, as HIVST is a relatively novel expanse of research, the three qualitative studies included in this review were besides plant to exist useful in understanding perceived concerns around adoption and scale-upwards of HIVST. Nine of eleven studies reported on acceptability of HIVST (Tabular array I), with acceptability rates ranging from 22.iii% (37) to 94% (12) beyond studies conducted in SSA. The bulk of studies around HIVST within SSA were conducted in South Africa (45%), Republic of kenya (36%) and Malawi (36%). Further emerging themes from the current scoping review included target populations, benefits of HIVST, need for counselling, linkage to intendance, usability of HIVST kits, costs of exam kits for HIVST, in terms of affordability and informing the calibration-up of HIVST.
Period chart depicting process of article selection for scoping study
Table I
Studies on acceptability of HIV Cocky-Testing in Sub-Saharan Africa
| Authors and Year | Country | Study Aim | Population | Sample Size (n) | Research Method | Acceptability Rate (%) |
|---|---|---|---|---|---|---|
| Kalibala et al., 2014 (7) | Kenya | To examine the acceptability of an unsupervised facility based HIVST intervention amid healthcare workers and their partners and factors associated with uptake of HIVST amid healthcare Workers. | Healthcare workers | 842 | Quantitative (Cantankerous sectional survey) | 85.3% |
| Kurth et al., 2015 (13) | Kenya | To evaluate the operation and accurateness parameters of unsupervised oral fluid HIVST among adult lay users in the general population of Republic of kenya. | Men | 240 | Quantitative (Prospective validation) | 94% |
| Macpherson et al., 2014 (38) | Republic of malaŵi | To test the hypothesis that offering optional home initiation of HIV care later on HIV cocky-testing might increase population level uptake of Art and increase willingness to test and to report positive results compared with HIV self-testing accompanied by facility based services merely. | Customs Healthcare Workers | 1200 | Quantitative (Cluster randomized trial) | 58.3% |
| Choko et al., 2011 (39) | Malawi | To test whether supervised oral cocky-testing could yield accurate results. Also explored reasons for accepting cocky-testing and respondent's preferences for HIV testing. | Community Healthcare Workers | 283 | Quantitative (Mixed method) | 56.4% |
| Choko et al., 2015 (40) | Malawi | To evaluate uptake, accuracy, linkage into care, and health outcomes when highly convenient and flexible simply supported access to HIVST kits was provided to a well-defined and closely monitored population. | Adults (16 years and older) | 16660 | Quantitative (Prospective report) | 84.one% |
| Maheswaran et al., 2016 (41) | Republic of malaŵi | To investigate the costs of both healthcare providers and users accessing HIVST or facility-based HTC. | Men | 1241 | Quantitative (Cluster randomized trial) | >lxx% |
| Brownish et al., 2015 (42) | Nigeria | A written report on the perspectives of informed members of the Nigerian public on the use of HIVST, including dialogue on needs prior to introduction. | Ethicists, researchers, those in academia, journalists, community advocates, activists and policy makers. | 5324 | Qualitative (Key informant) | 54.viii% |
| Van Dyk et al., 2013 (37) | South Africa | To explore how a sample of South African citizens felt about the various HIV testing models and to find out which testing model they preferred if given a choice betwixt client initiated, provider-initiated and self-testing for HIV. Participant'due south feelings near mandatory HIV counselling was too explored. | Men and Women | 466 | Quantitative (Survey) | 22.3% |
| Zerbe et al., 2016 (43) | Lesotho | This feasibility study explored the acceptability and uptake of domicile based cocky-testing in a sample of Basotho women and men. | Men and Women | 88 | Quantitative (Survey) | 67% |
Acceptability beyond different target populations
The majority of studies conducted in SSA included study populations of healthcare workers, policy makers, men only and general population. HIVST acceptability was higher among health professionals than customs health workers, the latter having levels like to the one study on policy makers and members of the civil club. Reviewed literature also highlighted the use of HIVST to admission hard-to-accomplish populations to test for HIV, only men were the only sub-population identified in two studies (6, 38–41). Four studies evaluated acceptability of HIVST on target populations inclusive of both men and women in SSA, with acceptability ranging from 22.3% to 94% (Tabular array I). In each of the 4 studies, men indicated higher acceptability for HIVST due to lower direct non-medical costs and not being absent from work (12, 37, 42, 43). As well, acceptability rates in studies with men only (12, 39) were college (70% – 94%) when compared to studies combining both men and women (22.3% – 64%) (12, 37, 39, 43). Uptake of HIV testing is lower among men using current HIV testing models, although there were no studies targeting women simply (44). Therefore, college acceptability rates among men suggests HIVST may be best suited to increment their uptake of HIV testing. Notwithstanding, further research is required to understand reasons for these gender-disparate lower acceptability rates of HIVST amidst women. Furthermore, time to come inquiry should include explicit descriptions of targeted general populations, likewise every bit sub-groups of key populations, and assess consistency of acceptability levels.
Benefits of HIVST
Evidence related to advantages and benefits of HIVST in SSA were reported in five studies (37, 38, 40, 41, 45). Several authors reported increased confidentiality and privacy, decreased brunt on healthcare system, decreased coercive testing past healthcare workers, and decreased stigma and bigotry associated with HIV testing as advantages of HIVST (37, 40, 41, 45). Autonomy to make ane's own pick of HIV testing method was besides cited as advantageous by van Dyk et al. (41). Makusha et al. (38) reported that HIVST has the potential to address gender disparate barriers to testing, often encountered by males at HIV testing centres, such as non-male friendly testing spaces, inconvenient operating hours and healthcare provider attitudes that may non be sensitive to men's needs. Also, study outcomes from current literature on the advantages of HIVST reiterate the argument that HIVST should be offered as a complementary HIV testing method to overcome current barriers associated with conventional HIV testing approaches (voluntary counselling and testing, provider-initiated counselling and testing, etc).
Drawbacks of HIVST
Despite compelling show around advantages of HIVST, policy makers, primal stakeholders and community members have reported several concerns associated with HIVST, which warrant further inquiry to ensure that HIVST scale-up is non compromised (6, 38, 40, 46–48). Determinative enquiry is required to address concerns identified during the scoping review, including lack of face-to-face counselling, poor linkage to care and potential for social harm.
Face-to-face counselling
Mixed reactions toward the need for face-to-face HIV counselling during HIVST were noted (37, 38, 40, 41, 45). Counselling is considered an essential component of all electric current testing models (38). In keeping with this perspective, studies conducted with academics, central stakeholders and community leaders perceived absence of face-to-face HIV counselling equally a disadvantage in two studies (38, 40). Cardinal stakeholders believed that complete lack of contiguous HIV counselling could lead to increased risk of distress and suicide (38). However, outcomes from the remaining two studies, involving both men and women from community, indicated the need to consider contiguous HIV counselling on the basis of user preference (41). Van Dyk et al. (41) reported 22.ii% of participants who felt that face-to-face HIV counselling was not necessary. Participants from some other newspaper published by van Dyk et al. (37) indicated that they were comfortable to test for HIV, simply did not want to be counselled by someone they did non know equally they would likely be negatively judged. Participants who were willing to examination for HIV through HIVST suggested phone counselling as a more than suitable counselling method when compared to face-to-face HIV counselling (37). Given varied preference to counselling in current studies in SSA, alternate methods to face-to-confront counselling should exist investigated.
Linkage to care
Linkage to intendance following a positive HIV result was highlighted as a major concern throughout literature from SSA which was identified during the scoping review (six, 38, twoscore, 41, 45, 48, 49). Researchers have found that adequate linkage to intendance, whereby participants access treatment or care facilities after testing for HIV, is an important component of the HIVST model and requires more formative research (6, 38, 39, 47–49). Choko et al. (49) reported 41.7% of participants linked to intendance following a positive HIV result in a study population of men and women. Lack of counselling may exist linked to inadequate linkage to intendance equally patients who test positive for HIV would non accept adequate information to access care and handling (38). Limited inquiry has been conducted on linkage to intendance post-obit HIVST. Algorithms and methods that ensure adequate linkage to care demand to be evaluated through future enquiry.
Social Harm
Incidents of harm such as suicide was not reported in the literature. However, Makusha et al. (38) reported that several stakeholders feared that people who test through HIVST may not be able to handle their results and actions taken by such people could exist harmful to them. Choko et al. (49) reported 3% of coercive testing by partners in their written report (38). Coercive testing may lead to gender-based violence between partners, just may as well be experienced betwixt family members. Potential for social harm through HIVST in SSA has mainly been reported through perceptions of customs wellness intendance workers and cardinal stakeholders (38, 49). Therefore, enquiry gaps exist for evidence of social damage from full general customs members and key populations using HIVST, and methods to prevent occurrence of social impairment should be designed and evaluated.
Usability of Exam Kits for HIVST
Rapid oral fluid HIV tests and rapid finger prick test kits were used in studies reviewed every bit part of scoping review (12, 47, 49). The overall business organisation raised across studies reporting on usability of HIVST kits was suitability of instructions for diverse target populations (6, 12, 50). Researchers reported that the language of instructions, and the information relevant to linkage to care should exist adequately recorded in user instructions (12, fifty). Nevertheless, limited research around usability of HIVST kits has been conducted in SSA, and therefore factors that tin contribute to an "ideal HIV self-testing kit" need to exist evaluated. Educational campaigns focused on usage of HIVST kits may be required for target populations not exposed to testing through HIVST (12). Equally literacy and pedagogy levels may vary greatly for individuals in resource limited settings, delivery method of educational campaigns promoting use of HIVST too as innovative approaches to the packaging of HIVST kits will be required.
Costs of test kits for HIVST
Varied responses relating to toll of HIVST kits were noted in literature within SSA (39, xl, 48). Some participants felt that the government should provide HIVST kits gratuitous of accuse, whilst others were willing to pay for HIVST kits if made available at distribution points that would ensure privacy and confidentiality such as pharmacies (38, 48). Co-ordinate to Dark-brown et al. (twoscore), accessibility of HIVST kits through pharmacies may increase admission to HIVST kits, however affordability may exist a business concern for those individuals who are geographically and socioeconomically disadvantaged. Kurth et al. (12) reported that affordability of HIVST was a main theme in their behavioural survey information nerveless. A consensus on cost and distribution point of HIVST kit could not be adamant as researchers across studies reviewed during the scoping review indicated that the cost and distribution point would be determined by the target population (38–40, 45, 48). Whilst limited enquiry show around appropriate price and distribution points of HIVST kits is available, future research should be directed toward identification of the nigh cost constructive HIVST kit and suitable distribution points for HIVST kits stratified past target populations.
Informing the scale-up of HIVST
Four of the 11 studies reported on policy and regulations related to HIVST (6, xl, 48, 49). Some countries inside SSA take reportedly integrated HIVST into their existing HIV testing policies, simply do not have acceptable policy and regulatory infrastructure to back up scale-up of HIVST (six, 48). Qualitative evidence from key stakeholder's, policy makers and healthcare professionals within communities in South Africa, Kenya and Malawi agreed that a policy and regulatory framework was essential for HIVST scale-upwards (38, 48). Van Rooyen et al. (48), Choko et al. (49) and Maheswaran et al. (42) reported that mechanisms to regulate cost, quality and reliability of HIV ST kits is required for scale-up of HIVST in line with WHO guidelines. Express bear witness around implementation of HIVST for scale-upwardly exists in SSA. Therefore, policy makers are unable to make informed decisions around calibration-up of HIVST. Thus, time to come research that provides testify around mechanisms to regulate cost, quality, reliability, distribution of HIVST kits and linkage to care is required to aid policy makers in developing a regulatory framework in line with WHO, UNAIDS and local land guidelines for scale-up of HIVST (39, 48, 49).
Word
The results of this scoping review revealed wide-ranging HIVST acceptability levels between 22% and 95% in SSA, consequent with findings from other regions of the world. However, a more unique pattern of gender disparities in HIVST acceptability rates was observed in studies within SSA, with acceptability rates of HIVST being much higher for men compared to women. Given men's natural disfavor of healthcare facilities in SSA, the review propose that men may prefer HIVST as it does not require for them to present at medical facilities for testing, oft associated with loss of income due to absenteeism from piece of work (41). Higher acceptability rates amongst men are consistent with studies conducted in adult countries among MSM populations (ten, eleven, 13–fifteen, 17–nineteen). On the contrary, routine HIV testing through VCT is presumably higher with women compared to men, as women access healthcare facilities through family unit planning, management of sexually transmitted infections and antenatal intendance during pregnancy (38). Women's inclination towards VCT may return HIVST generally less adequate to them compared to men, although certain sub-groups of women may really do good from HIVST. Therefore, further understanding of these gender disparities in preferential models for HIV testing is needed to inform policy and interventions to optimise HIV testing, including research on the potential role and affect of using HIVST to increase uptake of HIV testing and condition cognition amongst male populations, frequently considered difficult-to-accomplish in SSA. Research is lacking in SSA on the utilize of HIVST amidst MSM, FSWs and transgender key populations. On the contrary, the bulk of the enquiry on HIVST come from regions of the earth outside of SSA, predominantly adult countries, where the majority of studies were conducted among primal populations such equally MSM and FSWs (27).
Ultimately, adoption and scale-up of HIVST in SSA volition depend on the balance between potential benefits and related risks. On the ane hand, potential benefits of HIVST include testing of self in a confidential setting of personal option (48), testing opportunities for hard-to-reach populations (38, 51), autonomy in HIV testing (45) and reduction of stigma and discrimination impacts associated with testing at HIV testing facilities (52). Nonetheless, more robust studies are needed to demonstrate these benefits, and their affect on HIV testing uptake or knowledge of HIV status in conspicuously-defined target populations. Whilst the potential do good of abode-based cocky-testing on the individuals and their households necessitate further research, the presumed reduction of burden on human resource within the health system also calls for relevant research. Since most countries in SSA are resource-poor, toll-effectiveness studies and other resources-related benefits of HIVST will be paramount. On the other hand, risks associated with HIVST include potential for coercive testing already identified at a minor scale in this review, as well every bit concerns regarding potential self and social harms related to lack of counselling, and possible poor linkage to intendance following a positive test upshot. Conscientious monitoring and measurement of coercive testing, partner violence and suicide will be necessary in suitably-designed studies, as well equally the all-time approaches probable to mitigate these potential risks. Such data is needed to inform country-specific regulatory and policy frameworks for HIVST, as well every bit responsible scale-upwardly, which remain equally of import gaps globally (three, 13). In SSA, determinative research studies around costing, admission points, user-friendly examination kits packaging, monitoring and evaluation systems, quality assurance measures and advisable HIV counselling approaches are all the same required for the development of regulatory support systems and policy guidelines for implementation of HIVST (3, 23, 41).
Policy guidance volition too need to inform adoption of suitable HIVST test kits, taking into account diversity in target populations, options and reliability of testing methods, components of examination kits adopted, clarity of user instructions appropriate to varying literacy levels, disposal of the exam kit, counselling approaches and linkage to care options. Several studies have reported that evidence on the usability of HIVST kits remains limited globally, including major gaps in SSA (fourteen, 23, 24, 50). Global evidence on counselling approaches for HIVST is mixed, also observed in this review. According to a written report in Hong Kong, xvi% of MSM preferred HIVST due to absence of face-to-face counselling (53). Withal, a study in Peru reported 87% of participants required contiguous counselling by trained counsellors (26). International policy no longer advocates for confront-to-face HIV counselling, and suggests use of toll-free numbers for counselling (48), which highlights the need for further research to explore suitable counselling and grooming approaches for users of HIVST, with clear linkages to care (54). Whilst linkage to care may be hindered past travel costs to wellness facilities, a known barrier to admission, the toll and accessibility of HIVST test kits may establish the first barrier likely to prevent awareness of HIV condition. Participants in middle to high-income countries are more willing to pay for examination kits, when compared to participants from low-income countries (53). In SSA, toll to buy HIVST kits will likely compete with daily necessities such equally food and housing due to loftier levels of poverty to the exclusion of relatively wealthier individuals. As well, the price of the test kit will probable influence location of distribution points (13). These may include, but are not limited to local clinics, supermarkets, confined or restaurants and prophylactic distribution points (xix). Therefore, an affordable or a government-subsidised HIVST kit may exist required for successful scale-upwardly of HIVST to accommodate geographically hard-to-attain and poverty-stricken populations. Cost of HIVST kits has not been extensively evaluated globally, thus requiring boosted research to reduce the economic burden on an individual as well every bit limit cost implications for governments and other health providers.
CONCLUSIONS
Overall, this scoping review highlighted a broad range of acceptability rates for HIVST in SSA, very similar global rates, although men seem to benefit more than from HIVST than women. However, the trunk of research on HIVST is even so in its infancy stage relative to the global literature, except for research on policy guidance and frameworks on HIVST, which seems to lag behind beyond many countries of the world. Additional priorities for research on HIVST in SSA should be targeted at the information needed to inform scale-up and wider adoptions in the context of very diverse populations in educational activity, wealth, geographical access and most likely socio-cultural values. These enquiry priorities should include types of target populations, location of HIVST, packaging of exam kits, appropriate counselling services, social protection from harm, conducive policy frameworks, and demonstrable impact on the uptake of HIV testing and levels of HIV status awareness. Whilst HIVST has the potential to complement current HIV testing models which could lead to increased uptake of HIV testing, HIV status awareness and earlier initiation of Art, much implementation research piece of work is nonetheless needed in SSA to contribute towards prove base for the responsible scale-up of HIVST.
Acknowledgments
The authors thank the Centre for the AIDS Plan of Research in Due south Africa for their support.
Footnotes
Compliance with Ethical Standards
Disclosure of potential conflicts of interest
Author A declares that she has no conflict of interest. Author B declares that he has no conflict of interest.
Research involving human participants and/or animals
Ethical blessing: This article does non contain any studies with man participants or animals performed past whatsoever of the authors.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764831/
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