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Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe

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Johnson, Cheryl, Neuman, Melissa, MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613, Choko, Augustine, Quinn, Caitlin, Wong, Vincent, Hatzold, Karin, Nyrienda, Rose, Ncube, Getrude, Baggaley, Rachel, Terris-Prestholt, Fern and Corbett, Elizabeth (2020) 'Use and awareness of and willingness to self-test for HIV: an analysis of cross-sectional population-based surveys in Malawi and Zimbabwe'. BMC Public Health, Vol 20, Issue 779.

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Abstract

Background
Many southern African countries are nearing the global goal of diagnosing 90% of people with HIV by 2020. In 2016, 84% and 86% of people with HIV knew their status in Malawi and Zimbabwe, respectively. However, gaps remain, particularly among men. We investigated awareness and use of, and willingness to HIV self-test (HIVST) and explored sociodemographic associations before large-scale implementation.
Methods
We pooled responses from two of the first cross-sectional Demographic and Health Surveys to include HIVST questions in Malawi and Zimbabwe in 2015–16. We investigated sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and past use, awareness of, and future willingness to self-test using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with a completed questionnaire and valid HIV test result. We restricted analysis of willingness to self-test to Zimbabwean men, as women and Malawians were not asked this question.
Results
Of 31 385 individuals, 31.2% of men had never tested compared with 16.5% of women (p<0.001). For men, the likelihood of having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2% and 12.6%, respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio [aOR] = 1.55; 95% confidence interval [CI]: 1.37–1.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with greater willingness associated with having previously tested for HIV, being at high sexual risk (highest willingness [aOR=3.74;
95%CI: 1.39–10.03, p<0.009]), and being ≥25 years old. Wealthier men had greater awareness of HIVST than poorer men (p<0.001). The highest willingness to self-test (aOR=3.74; 95%CI: 1.39–10.03, p<0.009) was among men at high HIV-related sexual risk.
Conclusions
In 2015–16, many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience, willingness to self-test was high among Zimbabwean men, especially older men with moderate-to-high HIV-related sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale up. Programmes introducing, or planning to introduce, HIVST should consider including relevant questions in population-based surveys.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s12889-020-08855-7
Depositing User: Stacy Murtagh
Date Deposited: 27 May 2020 10:22
Last Modified: 27 May 2020 10:22
URI: https://archive.lstmed.ac.uk/id/eprint/14524

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