Acceptability and strategies for enhancing uptake of human immunodeficiency virus self-testing in Nigeria

Table 1 Search terms used in the literature search on human immunodeficiency virus self-testing uptake in Nigeria

Search terms	And	And
HIV self-testing	Acceptability	Nigeria
HIV regulatory	Nigeria	Self-testing
HIV self-testing	Preference	Nigeria
Nigeria HIV uptake	Self-testing Nigeria
HIV self-testing	Nigeria treatment	Linkage

HIV: Human immunodeficiency virus.

Table 2 List of papers reviewed

Ref.	Title	Study population	State of study	Objectives/research question	Study design	Findings
Adebimpe et al[7], 2019	How acceptable is the HIV/AIDS self-testing among women attending immunization clinics in Effurun, Southern Nigeria	All women of reproductive age (15-49 year) attending the immunization clinic (for their children) in Ekpan General Hospital	Delta	Assess the knowledge and acceptability of HIVST among women of childbearing age attending immunization clinics in Effurun, Southern Nigeria	Descriptive cross-sectional study	The study respondents’ high knowledge levels and acceptability of HIVST lend support to the fact that the procedure should be promoted in the stakeholders’ efforts to improve HIV testing among the general population
Adeoti et al[30], 2021	Sexual practices, Risk perception, and HIV Self-Testing acceptability among long-distance truck drivers in Ekiti State, Nigeria	Adult male long-distance truck drivers in Ado-Ekiti, Southwestern Nigeria	Ekiti	Examined the sexual practices, risk perception, and HIVST acceptability among long-distance truck drivers in Ekiti State, Nigeria	Cross-sectional study	Many long-distance drivers were engaged in unsafe sexual practices and were at risk for HIV transmission. Increasing testing using HIVST has the potential to bridge the gap in the diagnosis of HIV among long-distance drivers who are willing to be tested
Brown et al[27], 2015	HIVST in Nigeria: Public opinions and perspectives	Researchers, academics, journalists, community advocates, activists, and HIV policymakers and programmers, including those working in the development sectors, enlisted on the new HIV vaccine and microbicide advocacy society listserv	All states	Obtained perspectives of informed members of the Nigerian public on the use of the HIVST	Cross-sectional study	Cost-based pricing can be based on and directly tied to current product experiences and information as well as how crucial product monitoring is when pricing a product
Dirisu et al[28], 2020	‘I will welcome this one 101%, I will so embrace it’: A qualitative exploration of the feasibility and acceptability of HIV self-testing among MSM in Lagos, Nigeria	MSM	Lagos	Explored MSM perceptions of oral HIVST and potential barriers to and facilitators of HIVST use. In addition, it sought to identify operational and contextual issues that might affect the distribution of HIVST kits to MSM in the Nigerian context and the potential for linkage to care	Qualitative descriptive study	The potential of HIVST to increase the uptake of HIV testing among MSM in Nigeria was supportive of HIVST. Privacy and convenience offered by HIVST address concerns about stigma and waiting times associated with facility-based testing
Iliyasu et al[15], 2020	Acceptability and correlates of HIV self-testing among university students in northern Nigeria	University students	Kano	Examine the acceptability of HIVST and identify factors associated with the uptake of HIVST services among university students in Kano, Nigeria	Cross-sectional study	HTS uptake was low among a sample of university students in northern Nigeria, but most university students were willing to self-test for HIV
Iwelunmor et al[36], 2020	The 4 youth by youth HIV self-testing crowdsourcing contest: A qualitative evaluation	All young people between the ages of 10 year to 24 year in Nigeria	All states	Describe the responses to a crowdsourcing contest aimed at soliciting ideas on promoting HIVST among young people in Nigeria	Qualitative study	The study informed the development of innovative youth implementation strategies to increase the uptake of HIVST among adolescents and youth at risk for HIV
Agada et al[5], 2021	Reaching out to the hard-to-reach populations with HIV self-testing services in South-south Nigeria	General population	Cross River and Akwa-Ibom	Assess the impact of the total market approach deployed in Cross River and Akwa Ibom States in South-south Nigeria to enhance the demand for HIVST to ensure product equity, accessibility, and sustainability	Retrospective cross-sectional study	The HIVST model demonstrated the potential to be a vital tool in expanding HIV testing services and linking HIV care services to populations who would otherwise not have been tested
Dirisu et al[34], 2020	Exploring the regulatory context for HIV self-testing and PrEP market authorisation and use in Nigeria	PPMVs and CPs	Abuja, Rivers, Imo, Lagos, and Ogun	Assess HIVST/PrEP availability and market authorization; determine the facilitators and barriers to access; and identify existing systems that support the availability, appropriate use, affordability, and accessibility in the private sector in Nigeria	Cross-sectional study	About 63% of CPs and 27% of PPMVs sold HIVST kits, while 15% of CPs and no PPMV sold PrEP in their facilities. Most CPs (94%) and 33% of PPMVs who sold HIVST kits reported that their facilities were authorized to sell HIVST kits
Nwaozuru et al[26], 2019	Preferences for HIV testing services among young people in Nigeria	Youth aged 14–24 year	Lagos	Assessed preferences for HIV testing options among young people in Nigeria	Cross-sectional study	HIV testing services was optimized to reach young people in various options to meet their unique preferences
Ong et al[33], 2021	Designing HIV Testing and Self-Testing Services for young people in Nigeria: A discrete choice experiment	Nigerian youth (14-24 year)	Lagos	Examine the strength of Nigerian youth preferences related to HIV testing and HIVST	Discrete choice experiments	There could be demand for HIVST for Nigerian youth, who prefer HIVST kits that integrate testing for other STIs and is accessed from community health centres
Obiezu-Umeh et al[32], 2021	Young people’s preferences for HIV self-testing services in Nigeria: A qualitative analysis	Young people (14–24 year)	Lagos	Use qualitative methods to examine HIVST preferences among Nigerian youth	Cross-sectional study	HIVST preferences among Nigerian youth appeared to be influenced by several factors, including lower cost, less invasive testing method, location of testing, and linkage to care and support post-testing. Findings underscored the need to address young people’s HIVST preferences as a foundation for implementing programs and research to increase the uptake of HIVST
Obiezu-Umeh et al[51], 2020	Development of HIVST services through youth engagement: A qualitative evaluation of a health designation in Nigeria	Young people (14–24 year)	Lagos	Explore strategies for HIVST delivery developed at a designations contest in Nigeria	Cross-sectional study	Designations were a feasible method of facilitating meaningful youth engagement to develop deployable strategies to increase the uptake of HIV testing in young people in Nigeria
Durosinmi-Etti et al[38], 2021	Communication needs for improved uptake of PrEP and HIVST services among key populations in Nigeria: A mixed-method study	MSM, FSWs, and key influencers of the KP groups (health providers, peer educators, HIV program officers)	Akwa Ibom, Cross River, and Lagos	Identify the communication needs and preferences of the KP groups as evidence for developing strategies and interventions to increase awareness and use of HIVST and PrEP services among the KPs in Nigeria	Cross-sectional study	KPs effectively networked to increase awareness and access to PrEP and HIVST services in Nigeria. They will make the peers receptive to the interventions and help them reach other peers in their network, especially the hard-to-reach
Sekoni et al[37], 2022	Operationalizing the distribution of oral HIVST kits to MSM in a highly homophobic environment: the Nigerian experience	MSM and KOL	Lagos	Explore the operationalization of using KOLs to distribute HIVST kits to MSM	Cross-sectional study	This study showed the practical steps involved in operationalizing the KOL support system distribution of HIVST that positively influenced the testing experience for the participants irrespective of their HIV status and engagement in care. KOLs were a reliable resource to leverage for ensuring that HIVST kit was utilized, and HIV-positive individuals were linked to treatment and care in homophobic environments
Iwelunmor et al[52], 2022	Enhancing HIVST among Nigerian youth: Feasibility and Preliminary Efficacy of the 4 youth by youth study using crowdsourced youth-led strategies	Youth (14-24 year)	Lagos, Enugu, Ondo, and Oyo	Examine the feasibility and efficacy of crowdsourced youth-led strategies to enhance HIVST and STI testing	Quasi-experimental	The study provided promising evidence of efficacy that youth-led, crowdsourced strategies led to higher uptake of HIV and STI testing
Tun et al[35], 2018	Uptake of HIVST and linkage to treatment among MSM in Nigeria: A pilot programme using key opinion leaders to reach MSM	Males (17-59 year)	Lagos	Assess the feasibility, acceptability, uptake of HIVST, and linkage to HIV treatment among MSM through KOLs in Lagos, Nigeria	Cohort study	HIVST distribution through KOLs was feasible, and oral self-testing was highly acceptable among this urban MSM population. This study showed that linkage to treatment could be achieved with active follow-up and access to a trusted MSM-friendly community clinic that offers HIV treatment. HIVST should be considered an additional option to standard HIV testing models for MSM
Ugwu et al[29], 2020	HIVST: Perspectives from primary healthcare workers in Enugu State, Southeast Nigeria	Health workers in the primary health facilities	Enugu	Assess issues surrounding the HIVST from the perspectives of the primary healthcare workers in Enugu State	Cross-sectional study	Most of the primary healthcare workers in Enugu State had poor knowledge of HIVST
Iliyasu et al[31], 2022	HIVST and repeat testing in pregnancy and postpartum in Northern Nigeria	Pregnant women	Kano	Determine the predictors of willingness to self-test for HIV when retesting in pregnancy and postpartum among antenatal clients at a large teaching hospital in Northern Nigeria	Cross-sectional	The acceptability of HIVST for repeat testing in pregnancy and postpartum was low, but most respondents desired to be trained to self-test for HIV

AIDS: Acquired immune deficiency syndrome; CPs: Community pharmacists; HIV: Human immunodeficiency virus; HIVST: HIV self-testing; MSM: Men who have sex with men; HTS: HIV testing services; FSWs: Female sex workers; KOL: Key opinion leader; KP: key population; PPMVs: Patent and proprietary medicine vendors; PrEP: Preexposure prophylaxis; STI: Sexually transmitted infection.

Table 3 Target population for the included studies

Population	n	Frequency, %
Young people aged 15-24 yr	5	26.3
MSM	3	15.8
Key population influencers	2	10.5
Women of reproductive age	1	5.3
Long distance drivers	1	5.3
Professionals1	1	5.3
Student at university	1	5.3
General population	1	5.3
PPMV and CP	1	5.3
FSW	1	5.3
Males aged 17-59 yr	1	5.3
Pregnant women	1	5.3

¹Ethicists, researchers, those in the academia, journalists, community advocates, activists, and policymakers.

CP: Community pharmacists; FSW: Female sex workers; MSM: Men who have sex with men; PPMV: Patent proprietary medicine vendors.