Background
Methods
Data analysis
Results
Participants
Phase 1: Focus group discussions
Phase 1 (%) | Phase 2a (%) | Phase 2b (%) | |
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Gender | |||
Male | 19 | 10 | 20 |
Female | 16 | 10 | 20 |
Age (Median, interquartile range) | 19, 4 | 21, 2 | 21, 2 |
Highest level of education | |||
Primary | – | 1 (5) | 1 (3) |
Secondary | – | 7 (35) | 14 (35) |
Matric | – | 10 (50) | 14 (35) |
Tertiary | – | 2 (10) | 11 (28) |
Paid work in the past 6 months? | |||
Yes | – | 3 (15) | 4 (10) |
No | – | 17 (85) | 36 (90) |
When was the last time you were tested for HIV before today? | |||
Within the last 6 months | – | 13 (65) | 13 (33) |
6–12 months | – | 1 (5) | 11 (28) |
> 1–2 years | – | 3 (15) | 7 (18) |
> 2–5 years | – | 1 (5) | 2 (5) |
I never tested for HIV before today | – | 2 (10) | 7 (18) |
Where did you last test for HIV? | |||
At the clinic | – | 14 (77) | 20 (61) |
At an NGO | – | 4 (22) | 8 (24) |
At a private doctor | – | 0 | 1 (3) |
As part of a study | – | 0 | 4 (12) |
Phase 2a | Phase 2b | |||
---|---|---|---|---|
Oral fluid n = 20 (%) | Finger stick n = 20(%) | Oral fluid n = 32(%) | Finger stick n = 8(%) | |
Did you complete the HIV test today? | ||||
Yes | 20 (100) | 20 (100) | 31 (97) | 8 (100) |
No | – | – | 1 (3) | – |
Were you able to collect the sample? | ||||
Yes | 19 (95) | 20 (100) | – | – |
No | 1 (5) | – | – | – |
How comfortable did you feel collecting your own sample with the test kit? | ||||
Very comfortable | 16 (84) | 14 (70) | 24 (77) | 6 (75) |
Somewhat comfortable | 3 (16) | 4 (20) | 6 (19) | 2 (25) |
Somewhat uncomfortable | – | 2 (10) | 1 (3) | – |
How much pain did you feel when you collected your sample with the test kit? | ||||
No pain | 19 (100) | 17 (85) | 31 (100) | 8 (100) |
Not a lot of pain | – | 1 (5) | – | – |
A little pain | – | 2 (10) | – | – |
How easy or difficult was it to collect your sample with the test? | ||||
Very easy | 18 (95) | 12 (60) | 29 (94) | 7 (88) |
Somewhat easy | 1 (5) | 5 (25) | 2 (6) | 1 (13) |
Somewhat difficult | – | 3 (15) | – | – |
Most difficult part | ||||
Too many steps/too complicated | – | 1 | – | – |
Have a hard time with blood | – | 2 | – | – |
How easy or difficult was it to conduct the test once you had collected the sample? | ||||
Very easy | 18 (95) | 13 (65) | 27 (87) | 7 (88) |
Somewhat easy | 1 (5) | 7 (45) | 4 (13) | 1 (13) |
How easy or difficult was it to interpret the test results – in other words – to know if the test was positive or negative? | ||||
Very easy | 18 (95) | 18 (90) | 31 (100) | 8 (100) |
Somewhat difficult | 1 (5) | 2 (10) | – | – |
Do you trust the test result, meaning do you believe the result? | ||||
Yes | 19 (100) | 20 (100) | 31 (100) | 8 (100) |
How confident are you that you used the test correctly? | ||||
Very confident | 17 (89) | 11 (55) | 29 (94) | 7 (88) |
Somewhat confident | 2 (11) | 5 (25) | 2 (6) | 1 (13) |
Somewhat unconfident | – | 4 (20) | – | – |
How confident are you that you could use the test correctly in the future on your own? | ||||
Very confident | 19 (95) | 20 (100) | 31 (100) | 8 (100) |
Somewhat confident | 1 (5) | – | – | – |
Take a moment to think about when you used the HIV test. What did you like most about the test? (Please pick your top answer) | ||||
Trusted that results were accurate | – | 3 (15) | 1 (3) | – |
That the test was easy to use | 4 (20) | 5 (25) | 8 (26) | 1 (13) |
That the test was comfortable to use | 2 (10) | 1 (5) | 1 (3) | 1 (13) |
That I could do the test myself | 14 (70) | 10 (50) | 19 (61) | 5 (63) |
It was a new way to test for HIV | – | 1 (5) | 1 (3) | 1 (13) |
It used saliva to test for HIV | – | – | 1 (3) | – |
What did you like least about the test? | ||||
Fear of Pricking | – | 3 (15) | – | – |
Test was Painful | – | – | – | 1 (13) |
Waiting Time | – | – | – | 1 (13) |
There was nothing I disliked about the test | 20 (100) | 17 (85) | 31 (100) | 6 (75) |
For your next HIV test, would you prefer to go to the clinic or test yourself at home? | ||||
Health Worker | – | – | 8 (20) | – |
Do it yourself at home | 20 (100) | – | 32 (80) | – |
If you would prefer to test yourself at home, would you like someone to be there with you? | ||||
Yes | 11 (55) | – | 6 (19) | – |
No | 9 (45) | – | 26 (81) | – |
If you would like to have someone with you, who would you like to be there? | ||||
A friend | – | – | 1 (17) | – |
A family member | – | – | 4 (67) | – |
A sexual partner | – | – | 1 (17) | – |
If HIV self-test kits were available (like the one you used today), how likely is it that you would use one to test yourself for HIV? | ||||
Very likely | 18 (90) | – | 40 (100) | – |
Somewhat likely | 1 (5) | – | – | – |
Somewhat unlikely | 1 (5) | – | – | – |
If both tests (blood and saliva) were available in the future, which would you likely pick? | ||||
Blood | 6 (30) | – | 11 (28) | – |
Saliva | 11 (55) | – | 29 (72) | – |
No preference, I like both | 3 (15) | – | – | – |
How much would you pay for this HIV test kit (oral or blood, respectively)? | ||||
Range | 10–200 | 10–300 | 0–300 | – |
Phase 2a: Observation of both oral and blood-based test
Phase 2b: Observation of either oral or blood-based test
HIVST acceptability
Themes | Illustrative Quotations |
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HIVST acceptability | |
Testing independently |
“It is good because [HIVST] could reduce the rates of HIV because [some people] are afraid to be tested by other people. It is a good idea because a person will test alone and get the result alone… It’s good because you test at home. If you test positive, no one will know. You will keep it to yourself until you get ready to disclose… It is good for me because my status will be known by me only, if it happens that other people know, it would be me who disclose.” (22-year-old male)
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“I am very close to my best friend, so I would like to be with her when I do the test”(20-year old male)
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“I cannot tell my best friend, because she has secrets she don’t tell me some of the things about her life, so why should I have to tell her or be with her, it means she don’t trust me so why should I have to trust her, so I will tell one of my brother from the church, I trust him so much.” (18-year-old female)
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User preferences | |
Preferences for type of kit |
“I won’t tell my friends to use this test [blood based test] because they can feel the pains after using it. The saliva is better though the time to wait for the results is longer than this blood test. The main thing is getting the proper results as it is easy because you swab the saliva only.” (22-year-old male)
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“…We learned that HIV test can be easily be detected through blood or blood contamination. So now we are told that we can use saliva to test HIV. I don’t understand now. That is why people will prefer this blood test. It is the best.” (22-year-old male)
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Where to test |
Interviewer: “Do you think people of your age may have challenges in finding a place to do the test?”
P14: “They will have difficulties”. (20 years old)
I: “Where would they think they can do the test?”
P18: “They can do it in their rooms.” (20 years old)
P10: “At home sometimes we don’t have enough rooms we share our rooms. It would be better if there is a place like a voting station where we can do our test in private so that everyone will know their status alone. And there should be a dust bin there to throw rubbish in.” (18 years old) (male focus group) |
“Just create your own time, and to the test, use the little chance you get. Especially when you bath no you will take your time, people might think that you are bathing.” (21-year-old female)
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Materials accompanying the test kit |
“There should be a pamphlet in the kit that explains that has counselling message like written life goes on [even if you test positive].” (22-year-old male)
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Concerns about HIVST | |
Validity of HIVST results |
“How sure are you about this kit? I don’t trust this kit. Why should I have to go back to the clinic and get tested again after using [the HIVST kit] and [to potentially] test positive? I cannot use [the HIVST]. I’d rather go to the clinic and use blood test, not [the blood HIVST].” (18-year-old male)
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“The saliva test is not easy to me because if I test and the results are invalid, will I then go to the clinic to test again? [The reason that] I collected the kit privately was because I wanted to test [on my own] and I don’t want the nurses to know my status or results. So, I [don’t like HIVST]… I want the type of test that I can do alone rather than having to go to the clinic [for confirmation].” (22-year-old, male)
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Lack of emotional support |
“…I don’t understand this type of test because if I can find out that I am HIV positive the time I do the test privately I will think of a lot of things because there won’t be anyone who will support me or at least [in the clinic] I get counselling that will [tell me] what I should do if I am HIV positive because I can think of committing suicide.” (25-year-old male)
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Costs of test |
“I think at the clinic and chemist [pharmacy] are good places because this test is also for health.” (18-year-old male)
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“I don’t agree about getting the kit at the chemist because not everyone will afford it because we have to buy the kit and mostly youth are unemployed, so they won’t get money to buy those test kit at the chemistry.” (24-year-old male)
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