The results are presented in two sections. The first table and sections contain the demographics, social-economic and HIV risk for the respondents, the second sections data on the results for HIVST.
Demographics, Socio-economic & HIV Risk characteristics of participants
The majority of respondents were Kenyans at (92.6%), followed by Ugandans at (4.0%), Democratic Republicans of Congo and Rwandans were equal at (1.1%) respectively, Tanzanians (0.6%), Cote D’voire and Nigerians were distributed equally at (0.3%). A significant number of the respondents indicated that their income band was less than 60 USD at (49.3%), and USD 60 – 250 at (39.3%), with (9%) at USD 251 - 750 and (2.4%) at over USD 750. This means that 87% of the respondent’s monthly income range between USD
0 – 250. Half of the respondents at (50%) of the respondents identified themselves as men sex workers (MSW). Most of the respondents were homosexual followed by bisexual. About sixty eight percent (68%) of the respondents were ever married to a man and (28%) had been ever married to a woman. A majority of the respondents indicated that they had multiple sexual partners at (39.9%), those who indicated that they had two sexual partners in the past six months were (33.6%), the respondents who indicated to have had only one sexual partner in the period were (21.1%) with (5.4%) of the respondents indicating that they had no sexual partner in the last six months. Most of the respondents were versatile, they preferred being either on top or bottom. The above data is available on (Table,1) below.
Results on HIV self-test uptake.
Frequency of HIV/AIDS test
Among the MSM who have ever tested for HIV/AIDS, 246 (67%) of respondents had tested for HIV within 3 months retesting frequency and were the majority, while the respondents with more than 3 months retest at 121 (33%) with 44 (36.4%) having used self-test. There was a significant Chi-Square association between self-test and frequency of testing for HIV/AIDS P. Value = 0.011. The respondents with testing frequency greater than 3 months were 1.386 times as likely to test using a HIV self-test kit before.
Result of the most recent HIV test
Seventy six percent of the respondents (76%) 280 of the respondents had a negative result, 87 (24%) had a positive result from the last result. Among the clients who tested negative 134 (47.9%), had used HIV self-test kits and among those who tested positive 34 (39%) had also used HIV self-test kits.
Considered window period in deciding when to test
Forty six percent of the clients (46%)169 of the respondents indicated that they consider window period before testing and among them 86 (50.9%) had used self-test kit. 198 (54%) said they did not consider window period when testing.
STI screening frequency
The respondents who indicated that they screen for STI after 0-3 months were the majority at 280 (77%), over three months were at 86 (23%) of the respondents. There was a statistically significant Chi-Square dependency between respondents who had ever used a HIV self-test kit and the respondents STI screening frequency at P. Value =0.005. The respondents who’s STI screening frequency was over three months was at 1.525 times likely to test using a HIV self-test kit.
HIVST acceptability.
A significantly high population of the MSM at 76% considers HIV self-test as one of the HIV prevention combination prevention strategies with (47.9%) having used HIV self-test kits
Ever heard of HIV self-test
The interviewees who had ever heard of HIV self-test were 231 (63%) with 121(52%) indicating that they had used the HIV self-test kit. There was a statistically significant Chi- Square association between HIV self-test kit use and the respondents who had ever heard of a HIV self-test kit at P. Value = 0.001. The respondents who had ever heard of a HIV self-test kit were 1.374 times likely to test using a HIV self-test kit.
Ever heard of oral HIV Self-test
The respondents who had ever heard of oral HIV self-test 205 (56.0%) with 113 (55.1%) of this respondent who had used a HIV self-test kit. There was a statistically significant Chi-Square association between respondents who had ever used a HIV self-test kit and the respondents who had ever heard of an oral HIV self-test kit at P. Value = 0. 0001.The respondents who had ever heard of oral HIV self-test kit were 1.472 times likely to test using a HIV self-test kit.
Ever heard of blood sample HIV Self-test
The respondents who had ever heard of blood sample HIV self-test were 259 (71%) with 143 (55.2%) of this respondent who had used a HIV self-test kit. There was a statistically significant Chi-Square association between respondents who had ever used a HIV self-test kit and the respondents who had ever heard of a blood sample HIV self-test kit at P-Value <0.0001. The respondents who had ever heard of blood sample HIV self-test kit were 1.716 times likely to test using a HIV self-test kit.
Would prefer to use the Oral or Blood self-test kit
About fifty nine percent (59%) 181 of the respondents indicated that they would prefer a blood self-test kit with 89 (49%) of the respondents having used the self-test kit. About forty one percent (41%) 126 of the respondents of the respondents indicated that they would prefer an Oral self-test kit with 141 (45.9%) of the respondents having used either self-test kit. There was a statistically significant Chi-Square association between respondents who had ever used a HIV self-test kit and the respondent’s preference to use either the Oral or Blood self-test kit at P. Value <0.0001=0.039. The respondents who would prefer to use the Oral or Blood self-test kit were 1.243 times likely to test using a HIV self-test kit. There were mixed reactions on the preferred HIVST kit among the respondents who took part in the FGD for MSM and Key informant interviews from the healthcare workers. Oral self-test kits are preferred because they were easier to use and they did not require any pricking and were easily disposed. They were also reported to be less complicated. Blood self-test kits were preferred because they were considered more accurate, use of blood was considered more reliable for HIV testing, hence it would be easier to convince a client to take up a test. Below are few excerpts of the findings;
“To me I prefer oral because it is a self-test and it is easier for clients to use it and even disposing it is easier compared to the blood ones.” (Clinical Officer). “Personally, I think it would be oral, would want to give the oral which I think would be easier to explain to the client to apply the procedures and then most clients don’t like being pricked.” (Nurse)
“…for me I would go with the blood because even scientifically you know the HIV virus will target the cells which are in the blood but now these other science of using the mucus membrane a bit looks tricky…you need to convince this client that you are not targeting the saliva but you want the lining of the mucus membrane this patient may fail to understand what is this mucus membrane… you find that reliability of this test might bring conflict of interest.” (Clinical Officer).
What would prevent you from using the HIV oral test kit
Thirty three percent (33%) 104 of the respondents indicated that cost would prevent them from using the HIV oral self-test kit with 40 (38%) of the respondents having used a HIV self-test kit. Thirty two percent (32%) indicated that lack of knowledge would prevent them from HIV oral self. Inaccessibility and fear of the results were also some of the other reasons that were mentioned.
What would prevent you from using the HIV blood self-test kit
Twenty nine percent (29%) 89 of the respondents indicated that cost would prevent them from using the HIV blood sample self-test kit with 27 (30%) of the respondents having used a HIV self-test kit. Lack of knowledge of how to use the kits, fear of the results and inaccessibility of the kits were some of the other reasons that would hinder the respondents from using the blood sample test kits.
HIV positive through HIV self-test, would go for a confirmatory test
A high proportion of the respondents at 292 (80%) indicated that if they tested HIV positive through HIV self-test, they would go for a confirmatory test and among this respondent 135 (46.2%) had used a self-test kit, 75 (20%) indicated they would not go for a confirmatory test. There was a significant Chi-Square association between going for a confirmatory test if tested HIV positive through HIV self-test at P. Value =0.031. The respondents who would go for a confirmatory test if tested HIV positive through HIV self-test were 1.386 times as likely to test using a using a HIV self-test kit.
After how long would you go for a confirmatory test
About (92%) 332 indicated that they would go for a confirmatory test after within a month while 28 (8%) indicated they would not go to confirm the test.
Protection/Condom use after a positive test with your partner
Eighty six percent (86%) 315 of the respondents indicated that they would use protection/condom after a positive test with the partner and among them 152 (48.3%) had used a self-test kit. There was a statistically significant relationship between self-test kit use and the respondent’s protection/ condom use after a positive test with their partners at P. Value =0.019. The respondents who use protection or condoms with their partners were 1.338 times as likely to test use a HIV self-test kit. There were mixed reactions on the use of condoms after a positive HIV test with one respondent from the FGD reporting that condoms would only be used by a discordant couple and would not be used if both partners were concordant positive; “You go tested with your partner, if you are both positive there is no need, if one of you is negative then you use condoms”
Counselling after positive results.
A majority of the respondents indicated that they would go for counselling after positive results at 169 (46%) with 85 (50.3%) among the respondents having used a self-test kit. Majority of the study respondents from the FGD reported on the need for pre-test counselling before HIVST as this would provide an opportunity for clients to get all the information, they needed to make a decision after a HIV test and know where to go for follow up.
“It is usually accessed at a government facility, so even this self-test can be designated to specific pharmacies, the pharmacies should have a counseling room and should have a counselor who is sensitive and who has all the information about the HIVST and who can counsel for that such that there are no repercussions after the test and if you test positive, already you’ve been given the information you have them their so you know where to go, what to do and how to do a follow up.
Use condoms with partner after a negative test result
Eighty nine percent (89%) 325 of the respondents agreed that they would use condom with their partners despite a negative HIV test result and 155 (47.7%) indicated that they had used a HIV self-test kit. There was a statistically significant Chi-Square relationship between HIV self-test kit use and the respondent’s condom use with partners even after a negative HIV test result at P. Value =0.040. The respondents who tested negative and who would use condoms with their partner were 1.338 times as likely to test using a HIV self-test kit. FGD study respondents reported that they would also use condoms after a negative HIV test because it would prevent them from other diseases (STIs), it would prevent them should their partner be in the HIV window period or prevent them from HIV should the viral load of the sexual partner be undetectable.
Opinion on current cost
About sixty two percent of the respondents indicated that the estimated current market cost of the self-test kit was expensive with 120 (56.6%) having used the self-test kit. The respondents who felt that the current estimated self-test kit was affordable were at 155 (45.9%) and 48 (31%) among them had used a HIV self-test kit. There was a statistically significant Chi-Square relationship between cost of the test kits and use at a P- Value <0.0001. The respondents who thought that the current cost was expensive were 1.591 times not likely to test using a HIV self-test kit. The preferred cost of a HIVST kit was reported to be about 1 USD. One respondent reported that the cost of a kit should be free of charge for MSM. It was reported that there should be considerations for the job status of the client. Further it was reported that there should be considerations of cost for MSW who require frequent testing as captured by the following excerpt; “For instance the case of MSW, that person needs like frequent testing, you can’t say if the kit is going for let’s say 5 USD that person is going to use like 150 USD for 3 months for testing. You know this person is looking for money to feed themselves and then you start telling them about testing themselves?”
Preference point of picking the oral HIV self-test kit or what distribution channel would you prefer
A majority of the respondents at 169 (52.8%) indicated that they would prefer NGO facility/drop in center’s as distribution point, 70 (21.9%) indicated they would prefer to pick the test kits from the nearest government facility, 36 (11.6%) indicated that their point of preference to pick the kits to be Private hospital/Private clinic, the respondents who indicated that they would prefer to pick the kits from a retail or community pharmacy were 34 (10.9%). There was a recommendation from the FGD discussion that the government should be involved in the supply and provision of the HIVST kits; “Maybe the government should come up with a policy that the pharmacies should not sell these test kits; there should just be a place where people will be taking them.” One respondent however reported that local pharmacies would not be suitable to obtain HIVST kits as captured by the response below excerpts; “these people you know they know me, I know them, so whenever I am interacting with them they will know who I am and that one can expose me to security (insecurity).” In contrast however, another respondent reported that because the HIVST kit was for use by everyone, buying from a local pharmacy would not expose an MSM. “the self-test, is not for you personally, it’s not for MSM only, even people outside there they need the test, so if you go ask for a self-test they will not know and start stigmatizing you. You will just buy as you buy credit (airtime)”.
If test kit were to have hotline, which institution or organization would you prefer to provide the information
About (45%) 142 of the respondents indicated that they would prefer the hotline to be handled by a Drop in Centre with 65 (46%) among respondents having used the HIV self-test kit. 91(29%) indicated that they would prefer the information from the hotline relayed from a public hospital with 41 (45%) among this respondent having used a HIV self-test kit.
Using self-test for the first time would you prefer to have a treatment "buddy"
About sixty seven percent (67%) 207 of the respondents indicated that they would prefer a treatment buddy on the first time of self-test kit use with 108 (52%) of the respondents having used the self-test kit. There was a statistically significant Chi-Square association between respondents who had never used a HIV self-test kit and the respondents need of a treatment partner on first time use of HIV self-test kit at P. Value =0.014. The above table is available on (Table, 2) below.