Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 20, 2023; 13(3): 127-141
Published online Jun 20, 2023. doi: 10.5662/wjm.v13.i3.127
Acceptability and strategies for enhancing uptake of human immunodeficiency virus self-testing in Nigeria
Victor Abiola Adepoju, Chidinma Umebido, Ademola Adelekan, Ali Johnson Onoja
Victor Abiola Adepoju, Chidinma Umebido, Department of HIV and Infectious Diseases, Self testing in Africa (STAR) Project, Jhpiego Nigeria, Abuja 900901, Federal Capital Territory, Nigeria
Ademola Adelekan, Department of Public Health and Biological Sciences, Blue Gate Research Institute, Ibadan 200116, Oyo State, Nigeria
Ali Johnson Onoja, Department of Research, African Health Project, Abuja 900901, Federal Capital Territory, Nigeria
Author contributions: Adepoju VA and Adelekan A conceived the study; Onoja AJ provided overall guidance to the study; Adelekan A, Umebido C, and Adepoju VA conducted screening and led data extraction; Adelekan A and Onoja AJ drafted the manuscript; All authors read and approved the final version.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ademola Adelekan, DrPH, Researcher, Department of Public Health and Biological Sciences, Blue Gate Research Institute, Ibadan 200116, Oyo State, Nigeria. ademolaadelekan@gmail.com
Received: January 5, 2023
Peer-review started: January 5, 2023
First decision: March 15, 2023
Revised: April 1, 2023
Accepted: April 27, 2023
Article in press: April 27, 2023
Published online: June 20, 2023
Processing time: 166 Days and 0.6 Hours
Abstract
BACKGROUND

In 2019, the Nigerian Ministry of Health published the first operational guidelines for human immunodeficiency virus self-testing (HIVST) to improve access to human immunodeficiency virus (HIV) testing services among undertested populations in the country. Also, as part of the campaign to increase HIV testing services in Nigeria, the Nigerian Ministry of Health developed standard operating procedures for using HIVST kits.

AIM

To systematically review the acceptability and strategies for enhancing the uptake of HIVST in Nigeria.

METHODS

The systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Different databases were searched to get the necessary materials needed for this review. Standardized forms developed by the authors were used for data extraction to minimize the risk of bias and ensure that the articles used for the study were properly screened. Identified articles were first screened using the titles and their abstracts. The full papers were screened, and the similarities of the documents were determined. Qualitative, quantitative, and mixed-method studies were evaluated using the Critical Appraisal Skills Programme and Critical Appraisal Framework criteria.

RESULTS

All the publications reviewed were published between 2015 and 2022, with 33.3% published in 2021. Most (77.8%) of the studies were cross-sectional, 43.3% were conducted in Lagos State, and 26.3% were conducted among young people. The study revealed a high level of acceptability of HIVST. Certain factors, such as gender, sexual activity, and previous testing experience, influence the acceptability of HIV self-testing, with some individuals more likely to opt-out. The cost of the kit was reported as the strongest factor for choosing HIVST services, and this ranged from 200 to 4000 Naira (approximately United States Dollar 0.55-11.07), with the majority willing to pay 500 Naira (approximately United States Dollar 1.38). Privately-owned, registered pharmacies, youth-friendly centres, supermarkets, and online stores were the most cited access locations for HIVST. The least influential attribute was the type of specimen needed for HIVST. Strategies addressing cost and preferred access points and diverse needs for social media promotion, local translation of product use instructions, and HIVST distribution led by key opinion leaders for key populations were found to significantly enhance HIVST uptake and linkage to care.

CONCLUSION

HIVST acceptability is generally high from an intention-to-use perspective. Targeted strategies are required to improve the acceptability of HIV self-testing, especially among males, sexually active individuals, and first-time testers. Identified and proposed uptake-enhancing strategies need to be investigated in controlled settings and among different populations and distribution models in Nigeria.

Keywords: Acceptability; HIV self-testing; Uptake; Intention-to-use; Regulation; Linkage to care

Core Tip: This is the first systematic literature review on the acceptability and uptake of human immunodeficiency virus self-testing (HIVST) in Nigeria. The findings suggested that the acceptability of HIVST is high in Nigeria. However, the actual use of HIVST in programmatic implementation was lower than expected. The use of key opinion leaders among key populations successfully increased the acceptability and uptake of HIVST. However, cost was a major barrier to the acceptability of HIVST. More studies are required to evaluate how the uptake of HIVST compares in routine programs vs real-life settings in the absence of support and resources that enhance HIVST uptake.