Biomedical Research and Training Institute, Harare, Zimbabwe.
Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
J Int AIDS Soc. 2021 Sep;24(9):e25815. doi: 10.1002/jia2.25815.
INTRODUCTION: In sub-Saharan Africa, less than half of young people know their HIV status. HIV self-testing (HIVST) is a testing strategy with the potential to offer privacy and autonomy. We aimed to understand the uptake and acceptability of different HIV testing options for youth in Harare, Zimbabwe. METHODS: This study was nested within a cluster randomized trial of a youth-friendly community-based integrated HIV and sexual and reproductive health intervention for youth aged 16-24 years. Three HIV testing options were offered: (1) provider-delivered testing; (2) HIVST on site in a private booth without a provider present; and (3) provision of a test kit to test off site. Descriptive statistics and proportions were used to investigate the uptake of HIV testing in a client sample. A focus group discussion (FGD) with intervention providers alongside in-depth interviews, paired interviews and FGDs with a selected sample of youth clients explored uptake and acceptability of the different HIV testing strategies. Thematic analysis was used to analyse the qualitative data. RESULTS: Between April and June 2019, 951 eligible clients were tested for HIV: 898 (94.4%) chose option 1, 30 (3.25%) chose option 2 and 23 (2.4%) chose option 3. Option 1 clients cited their trust in the service and a desire for immediate counselling, support and guidance from trusted providers as the reasons for their choice. Young people were not confident in their expertise to conduct HIVST. Concerns about limited privacy, confidentiality and lack of support in the event of an HIV-positive result were barriers for off-site HIVST. CONCLUSIONS: In the context of supportive, trusted and youth-friendly providers, youth clients overwhelmingly preferred provider-delivered HIV testing over client-initiated HIVST or HIVST off site. This highlights the importance of listening to youth to improve engagement in testing. While young people want autonomy in choosing when, where and how to test, they do not want to necessarily test on their own. They desire quality in-person counselling, guidance and support, alongside privacy and confidentiality. To increase the appeal of HIVST for youth, greater provision of access to private spaces is required, and accessible pre- and post-test counselling and support may improve uptake.
介绍：在撒哈拉以南非洲，不到一半的年轻人了解自己的艾滋病毒状况。艾滋病毒自我检测（HIVST）是一种具有提供隐私和自主权潜力的检测策略。我们旨在了解津巴布韦哈拉雷的年轻人对不同艾滋病毒检测选择的接受程度和可接受性。 方法：这项研究是在一项针对 16-24 岁青少年的以青年为中心的社区为基础的综合艾滋病毒和性与生殖健康干预措施的集群随机试验中进行的。提供了三种艾滋病毒检测选择：（1）由提供者提供的检测；（2）在没有提供者在场的私人摊位中进行的现场 HIVST；（3）提供现场外测试的测试包。使用描述性统计和比例来调查客户样本中艾滋病毒检测的采用情况。与干预提供者一起进行焦点小组讨论（FGD），以及对选定的青年客户样本进行深入访谈、配对访谈和 FGD，以探讨不同艾滋病毒检测策略的采用情况和可接受性。使用主题分析对定性数据进行分析。 结果：在 2019 年 4 月至 6 月期间，对 951 名符合条件的客户进行了艾滋病毒检测：898 名（94.4%）选择了选项 1，30 名（3.25%）选择了选项 2，23 名（2.4%）选择了选项 3。选择选项 1 的客户表示，他们对服务的信任以及对立即获得值得信赖的提供者提供咨询、支持和指导的渴望，是他们选择的原因。年轻人对自己进行 HIVST 的专业知识没有信心。对隐私有限、保密性和在 HIV 阳性结果时缺乏支持的担忧是现场外 HIVST 的障碍。 结论：在支持、值得信赖和以青年为中心的提供者的背景下，青年客户绝大多数更喜欢由提供者提供的艾滋病毒检测，而不是由客户发起的 HIVST 或现场外的 HIVST。这突出表明，倾听年轻人的意见对于提高他们对检测的参与度非常重要。虽然年轻人希望在何时、何地以及如何检测方面拥有自主权，但他们并不一定希望独自进行检测。他们希望获得高质量的面对面咨询、指导和支持，同时还希望保护隐私和保密性。为了提高 HIVST 对年轻人的吸引力，需要更多地提供私人空间，并且可以提供便捷的检测前和检测后咨询和支持，以提高检测的采用率。
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