Background: With 61% of men and 31% of women aged 15-49 never tested as of 2009, HIV testing is a priority in Lesotho. HIV self-testing is one potential strategy to address low testing rates and achieve universal testing coverage, by complementing voluntary and provider-initiated testing. However, little is known about the acceptability of self-testing in Lesotho. This feasibility study explored the acceptability and uptake of home-based self-testing (HBST) in a sample of Basotho women and men.
Methods: Between December 2013 and May 2014, 45 HIV-positive index participants (IPs) were recruited from 4 health centers in Mafeteng and Mohale’s Hoek in Lesotho as part of the NIH-funded Enhanced Prevention in Couples (EPIC) study. Home visits were scheduled with IPs to offer HIV testing to their household (HH) members. HH members were offered two options for testing: (1) standard HIV counseling and testing (SCT); or (2) HBST with OraQuick ADVANCE HIV-1/2, followed by confirmatory standard HIV testing. Demographic and acceptability measures were collected through in-person surveys.
Results: Seventy-three percent of IPs were recruited from antenatal and 24% from TB clinics; 84% of IPs were women. A total of 88 HH members were offered testing, and 59 (67%) accepted; 78% of men and 61% of women agreed to test. Almost all (98%) participants chose the HBST option. All HBST participants described the self-testing process as “easy” or “very easy”; 12% required extra instruction. Participants were asked to identify positive and negative aspects of HBST. Ninety-eight percent of participants reported only positive qualities, including the home visit itself (32%); the openness and respectfulness of the study team (25%); the pain-free testing method without need for a prick or blood-draw (25%); the ability to test oneself (19%); being the first to know one’s status (14%); the simplicity of the testing procedure (14%); the privacy and confidentiality of testing at home (7%); having an option for testing (standard or self) (7%); and the rapidity of the test (7%). Nearly all participants reported that they would recommend HBST to friends and family. Thirteen percent of participants were newly diagnosed as HIV-positive.
Conclusions: This study demonstrates high levels of uptake and acceptability for HBST and the feasibility of utilizing HIV-positive index individuals as a way to reach others in their households, who may not access health facilities. Successfully reaching men is an added advantage.