"I will choose when to test, where I want to test": Investigating young people's preferences for HIV self-testing in Malawi and Zimbabwe

Objectives

This study identifies young people’s preferences for HIV self-testing (HIVST) delivery, determines the relative strength of preferences and explores underlying behaviors and perceptions to inform youth-friendly services in southern Africa.

Design

A mixed methods design was adopted in Malawi and Zimbabwe and includes focus group discussions (FGD), in-depth interviews (IDI) and discrete choice experiments (DCE).

Methods

This study was conducted during the formative phase of cluster randomized trials of oral-fluid HIVST distribution. Young people aged 16-25 years were purposively selected for IDIs (n=15) in Malawi and 12 FGDs (n=107) across countries. A representative sample of young people were administered a DCE on HIVST delivery, with data analyzed to estimate relative preferences for service characteristics. The qualitative results provided additional depth and were triangulated with the quantitative findings

Results

There was strong concordance across methods and countries based on the three triangulation parameters: product, provider and service characteristics. HIVST was highly accepted by young people, if provided at no or very low cost. Young people expressed mixed views on oral-fluid tests, weighing perceived benefits with accuracy concerns. There was an expressed lack of trust in health providers and preference for lay community distributors. HIVST addressed youth-specific barriers to standard HIV testing, with home-based distribution considered convenient. Issues of autonomy, control, respect, and confidentiality emerged as key qualitative themes.

Conclusion

HIVST services can be optimized to reach young people if products are provided through home-based distribution and at low costs, with respect for them as autonomous individuals.