Bridging Barriers to Clinic-Based HIV Testing with New Technology: Translating Self-Implemented Testing for African American Youth

Numerous barriers to clinic-based HIV testing exist (e.g., stigmatization) for African American youth. These barriers may be addressed by new technology, specifically HIV self-implemented testing (SIT). 

We conducted a series of formative phase 3 translation studies (49 face-to-face interviews, 9 focus groups, 1 advisory panel review) among low-income African American youth (15–19 years) and providers of adolescent services in two US cities to identify potential translation difficulties of the OraQuick SIT. Based on content analysis, we found that providers and African American youth viewed SITs positively compared to clinic-based testing. 

Data suggest that SITs may reduce social stigma and privacy concerns and increase convenience and normalization of HIV testing. Challenges with SIT implementation include difficulties accessing confirmatory testing, coping with adverse outcomes, and instructional materials that may be inappropriate for low socioeconomic status (SES) persons. 

Study results underscore the need for translation studies to identify specific comprehension and implementation problems African American youth may have with oral SITs.

Table 2

Focus group: adolescents’ perceptions of SIT

Advantages of SIT

[Privacy/confidentiality] “Because a lot of people don’t want to go see the doctor.”

[Privacy/confidentiality] “They isn’t got to be sitting in the doctor’s office looking at everybody, like I can’t believe I’m in here.”

[Privacy/confidentiality] “I hate going to the doctor, and everybody, oh, what are you here for? And I be like, I need to get tested, and they be like, huh?”

[Privacy/confidentiality] “…in my school…they have free HIV testing…So if they see you go to [the] trailer…like why are you getting yourself checked baby?…And they might start rumors.”

[Convenience] “So it’s fast. So you find out right away.”

[Convenience/repeat testing] “…You always have it on hand. Like, you can buy, like, two or three and just keep it in your, like, medicine cabinet. And, like, you want to check it every three—you want to check yourself every 3 months…”

SIT disadvantages

[Procedural difficulties]:

[Instruction reading level] “You might have to read it with your auntie or somebody. You know what I’m saying?”

[Misreading the test stick] “How to read it [test stick] correctly.”

[Poor implementation leading to erroneous results] “…If you do it wrong and then you get like the wrong result…”

[False positives] “But you’ll be thankful at the same time ‘cause you went home and it say positive, but you go to the doctor it say negative, you’re like, ‘Yeah, well, I have a feeling I isn’t got it.’ But bullshit I’m going to get my money back. Like, this test didn’t work, so go on here…”

[Negative emotional reactions] “…like some people don’t react to that in the proper way. Like some people might go suicidal…”

[Being discovered using the test] “Who will find out. Like, if I’m not trying to tell my mother and then she walk in the bathroom while I’m like swabbing myself, then you just like, uh, see.”

[Costs] “…Dang, $40.00?”

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By:  J. A. Catania, Ph.D., M. M. Dolcini, Ph.D., G. W. Harper, M.P.H., Ph.D., D. P. Dowhower, M.P.H., L. G. Dolcini-Catania, S. L. Towner, M.S., Ph.D., A. Timmons, M.A., D. N. Motley, B.A., and D. H. Tyler, Ph.D.

College of Public Health and Human Sciences, Oregon State University, Corvallis, OR USA

School of Public Health, University of Michigan, Ann Arbor, MI USA

Department of Psychology, DePaul University, Chicago, IL USA

DePaul Family and Community Services, Chicago, IL USA

School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR 97331 USA

Departments of Psychology and Sociology, University of Oregon, Eugene, OR USA

J. A. Catania, Email: ten.tsacmoc@1591ainatac.

  

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