HIV Insight: Attitudes and Acceptability on HIV Self-Testing among Key Populations: A Literature Review

HIV self-testing (HIVST) is a potential strategy to overcome disparities in access to and uptake of HIV testing, particularly among key populations (KP). A literature review was conducted on the acceptability, values and preferences among KP. Data was analyzed by country income World Bank classification, type of specimen collection, level of support offered and other qualitative aspects. Most studies identified were from high-income countries and among men who have sex with men (MSM) who found HIVST to be acceptable. In general, MSM were interested in HIVST because of its convenient and private nature. However, they had concerns about the lack of counseling, possible user error and accuracy. Data on the values and preferences of other KP groups regarding HIVST is limited. This should be a research priority, as HIVST is likely to become more widely available, including in resource-limited settings...

Privacy was more frequently reported as a benefit of HIVST in studies using an unsupervised approach (n = 5/6) [15, 30, 38, 45, 46] compared to those using a supervised approach (n = 2/6) [35, 37]. Although approach was not reported 71 % of MSM in Brazil, reported that HIVST would offer more privacy than HIV testing facilities [43]. In general, the benefits for HIVST described by participants across studies, remain similar; even when analyzed by country income, type of KP, participant education level, type of specimen collection, having performed an HIVST and type of approach...

Willingness to pay for a HIVST kit if sold was documented in 11 articles [16, 31, 35, 37, 39, 41, 42, 44–47]. Willingness to pay varied across population, country income settings, type of specimen collection, and type of approach. In HIC settings, study participants were willing to pay between ≤US$20 and ≥US$50 [16, 37,39, 42, 44–46]. In MIC settings, participants were generally willing to pay between (US$1 to US$20) [41,47]. A study from China reported that MSM were willing to pay US$6.50 (US$3–US$11), slightly more than female sex workers (FSW) who were willing to pay US$5 (US$2–US$8) [47]. In LIC settings, participants were willing to pay between US$0.54–US$4.35 [31]. According to this study in Kenya, MSM were willing to pay (US$3.35), slightly more than FSW who were willing to pay US$3.10 [31].

Participant willingness to pay in all supervised HIVST studies (n = 4/11) ranged between (≥US$1 to ≥US$20) [16, 37, 42, 44]. In 2/11 studies using an unsupervised approach, participants were willing to pay between (>US$20 to ≥US$50) [45, 46]. Reluctance to pay (range 5.2–11 %) was only reported in four studies where MSM and FSW participants have performed an HIVST, these studies examined both approaches and were in MIC and HIC settings [16, 35, 39, 47]; all but one used oral fluid-based HIV RDT [16, 35, 47]...

Below: Studies evaluating HIV self-testing acceptability