HIV self-testing (HIVST) is a strategy recommended by WHO to increase testing, especially among key populations, men and young people. In May 2019, an HIVST pilot began in Zambézia province involving 14 public/ private pharmacies (4 urban, 10 rural), allowing clients to purchase up to two oral HIV self-tests at a subsidized price of 50Mzn (~$US 0.80). The study assessed the acceptability and use of this strategy.
Exit-surveys were conducted in a random sample of 20 clients per pharmacy, independently from test purchase. A survey was also done for a random sample of up to 10 clients per pharmacy who bought a test and accepted being contacted later. Structured questionnaires were used assessing perceptions on HIVST; clients contacted after test purchase were additionally asked about its use. Analysis (X2-test) was done for each variable comparing clients who purchased versus not. Sales were monitored using pharmacy-based registers.
During the first 3 months, 517 adults purchased 603 tests (70% male, 41% <30 years).
A total of 351 pharmacy clients participated in the surveys: 259 who did not buy a test and 92 who bought one. Median age was 29 years [IQR 23-37], 65% male, 60% married and 63% with a ≥12th grade education level. The most frequently reported advantage of HIVST was confidentiality, while primary disadvantages were lack of counseling and fear of test result (Table 1). Eighty-five (24%) clients found the test expensive.
From the 92 who bought a test, 73 participated in the additional survey, of whom 67 (93%) performed the test. Self-reported easiness of test instructions and test performance was 34% and 45%, respectively. Almost all (97%) were confident in the result, but 27 (40%) felt they needed additional information or counseling. Before doing the test, 49% felt very anxious, and 37% felt very anxious after the test awaiting results. Self-test result was revealed by 40 (60%) (one HIV-positive), with 15% reporting linking to a health facility to confirm their result.
HIVST at public/ private pharmacies was successfully employed, reaching male and young people. The cost, although small, might be a barrier. The perceived lack of counseling is concerning, suggesting a need for specific tools at pharmacies and/or offering assisted testing. Moreover, to attain the first 95 of the UNAIDS 95-95-95 goals, other strategies (e.g. index-case HIVST) should also be considered.