Enablers and barriers to effective HIV self-testing in the private sector among sexually active youths in Nigeria: A qualitative study using journey map methodology

PLoS One. 2023 Apr 27;18(4):e0285003. doi: 10.1371/journal.pone.0285003. eCollection 2023.

Abstract

Background: HIV is a public health burden in Nigeria. HIV self-testing is one of the approaches to testing, which is the first of the 95:95:95 cascade of a coherent response to the epidemic. The ability to self-test HIV is influenced by various factors that can either serve as enablers or barriers. Exploring these enablers and barriers to the uptake of HIVST will help achieve optimal HIV self-testing and provide a deeper understanding of the HIVST kits users' journey.

Objective: The purpose of the study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology.

Methods: We conducted a qualitative exploratory study between January 2021 to October 2021 to understand the journey map for taking up and using HIVST in the private health delivery systems which include the pharmacies and PPMVs. 80 youths in Lagos, Anambra and Kano states were interviewed using IDIs and in-person FGDs. Their responses were audio-recorded, transcribed and analyzed using a qualitative software package (Nvivo software).

Results: A journey map for taking up and effectively using HIVST using the private sector among sexually active youths using key enablers and barriers at the attract, purchase, use, confirmation, linkage, and reporting stage was developed. The major enablers among participants were privacy and confidentiality, bundling purchases with other health products, easy-to-use instructions, and past experience with other self-testing kits. The major barriers were fear of discrimination, big packaging, high price, lack of confidence from user error and fear of status disclosure.

Conclusions: Sexually active young people's perspectives enhance our understanding of the barriers and enablers of using HIVST through the private sector. Optimizing the enablers such as improved confidentiality that may be seen in e-pharmacy, reducing barriers and factoring sexually young people's perspectives will enhance the market and the uptake of HIVST towards ensuring sustainability and accelerating progress towards the 95-95-95 targets.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • HIV Infections* / diagnosis
  • HIV Infections* / epidemiology
  • Humans
  • Mass Screening / methods
  • Nigeria
  • Private Sector
  • Qualitative Research
  • Self-Testing*

Grants and funding

This study was possible by the generous support of Children’s Investment Fund Foundation (CIFF) - Global Fund partnership through the Population Services International (PSI). The contents herein are the sole responsibility of the authors and do not necessarily reflect the views of SFH, PSI or CIFF. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.