Experiences, Perceptions, and Suggestions for Future Use of HIV Self-Testing Through Community Distribution Channels Among Adolescents and Young Adults in Nairobi, Kenya: A Qualitative Analysis

Abstract

Background: Adolescents and young adults (AYA) have lower rates of HIV testing compared to adults in sub-Saharan Africa. Community-based delivery of oral HIV self-testing (HIVST) is a promising approach that may increase HIV testing uptake for AYA. Eliciting youth perspectives can help to optimize these services. Methods: This qualitative study explored experiences completing oral HIVST through community-based distribution and recommendations for future HIVST programs among high-risk AYA in Kenya. We conducted nine focus group discussions (FGDs) with HIV negative AYA ages 15-24 who had completed oral HIVST as part of the Youth Engaged in Self-Testing (YES) study. The YES study evaluated community-based distribution through homes, pharmacies, and ‘hotspots’ (bars/nightclubs) channels. FGDs were stratified by channel (three groups per channel) and age (15-17, 18-24), and were audio recorded, transcribed, and translated into English (when necessary). Thematic analysis was used to identify HIVST experiences and recommendations. Results: Of 61 AYA participants, 66% were female, 72% were 18-24 years old, and 31% had romantic partners. Participants valued HIVST because it promoted autonomy further and was more convenient than traditional clinic based testing. For many, the HIVST experience gave them confidence to test again, and promoted positive behavior change including the use of condoms during sexual encounters to stay HIV negative. Testing HIV negative also helped facilitate talking about testing with partners. When considering future HIVST, AYA wanted individualized, ongoing support during and after testing, including post-test counseling and linkage to care. Participants desired peer involvement in the entire HIVST process and recommended offering multiple options to obtain HIVST and support including in-person, social media, and varied community-based distribution points such as bars, pharmacies, and youth centers. Conclusions: HIVST meets the needs of adolescents because it provides convenient and autonomous testing experiences. Future community-based HIVST programs should include multiple distribution points and trained peer educators in all steps of distribution, testing, and follow-up to optimize this testing strategy.