Barriers and Facilitators to the Uptake of HIV Self-Testing and Entry into Care: A Qualitative Study on Users’ Experiences from the Community-Based Distribution Model of the STAR Program in South Africa.

Abstract

The research proposed in this paper is centered around the emerging approach of HIV self-testing (HIVST) as an intervention to increase the uptake of HIV testing services for under-tested segments of the population in South Africa, a country with the highest number of people living with HIV in the world. Under the STAR (Self-Testing AfRica) initiative program, approximately 1.1 million HIVST kits were distributed in South Africa to increase the access to and use of HIVST. The aim of this study was to discover what users’ experiences of HIVST were, in order to understand what factors formed the barriers and facilitators to the uptake of HIVST and entry into care post-use. A qualitative methodology was used in conducting in-depth interviews with recipients of HIVST from the community-distribution model of the STAR program in South Africa [n=16]. The findings of this paper show that an interest in HIVST as a new form of testing and a perceived risk of HIV motivated the use of HIVST. The main facilitators of HIVST were a preference for oral-fluid based testing, the ability to circumvent facility-based barriers, disclosure over one’s status and privacy. The main barriers to HIVST that this paper found were a lack of familiarity with HIVST and concerns over the validity of HIVST. Furthermore, this paper found that for users who received a negative result, the HIVST served as a catalyst to engage in preventative health behavior, including more frequent testing. The results showed that users who received a positive result attended confirmatory testing and entered into care. The findings indicate that HIVST facilitated users’ motivation to receive treatment for HIV by providing information on the process of entering into care and behavioral control to do so. The main implication of the results of this study is that HIVST has the potential to facilitate the uptake of testing, and that the benefits of HIVST outweigh the potential deterrents that stem from a lack of familiarity with HIVST. Future research on users’ experiences with HIVST should be emphasized and incorporated into the design of interventions to distribute kits, in order for HIVST to effectively increase testing and entry into care for under-tested segments of the population in South Africa.