Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study
Abstract Background HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-04-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-024-09231-1 |
| _version_ | 1797219994467041280 |
|---|---|
| author | Ailva O’Reilly Webster Mavhu Melissa Neuman Moses K. Kumwenda Cheryl C. Johnson George Sinjani Pitchaya Indravudh Augustin Choko Karin Hatzold Elizabeth L. Corbett |
| author_facet | Ailva O’Reilly Webster Mavhu Melissa Neuman Moses K. Kumwenda Cheryl C. Johnson George Sinjani Pitchaya Indravudh Augustin Choko Karin Hatzold Elizabeth L. Corbett |
| author_sort | Ailva O’Reilly |
| collection | DOAJ |
| description | Abstract Background HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has largely been oral-fluid-based. We investigated whether users preferred blood-based (i.e. using blood sample derived from a finger prick) or oral fluid-based HIVST in rural and urban Malawi. Methods At clinics providing HIV testing services (n = 2 urban; n = 2 rural), participants completed a semi-structured questionnaire capturing sociodemographic data before choosing to test using oral-fluid-based HVST, blood-based HIVST or provider-delivered testing. They also completed a self-administered questionnaire afterwards, followed by a confirmatory test using the national algorithm then appropriate referral. We used simple and multivariable logistic regression to identify factors associated with preference for oral-fluid or blood-based HIVST. Results July to October 2018, N = 691 participants enrolled in this study. Given the choice, 98.4% (680/691) selected HIVST over provider-delivered testing. Of 680 opting for HIVST, 416 (61.2%) chose oral-fluid-based HIVST, 264 (38.8%) chose blood-based HIVST and 99.1% (674/680) reported their results appropriately. Self-testers who opted for blood-based HIVST were more likely to be male (50.3% men vs. 29.6% women, p < 0.001), attending an urban facility (43% urban vs. 34.6% rural, p = 0.025) and regular salary-earners (49.5% regular vs. 36.8% non-regular, p = 0.012). After adjustment, only sex was found to be associated with choice of self-test (adjusted OR 0.43 (95%CI: 0.3–0.61); p-value < 0.001). Among 264 reporting blood-based HIVST results, 11 (4.2%) were HIV-positive. Blood-based HIVST had sensitivity of 100% (95% CI: 71.5–100%) and specificity of 99.6% (95% CI: 97.6–100%), with 20 (7.6%) invalid results. Among 416 reporting oral-fluid-based HIVST results 18 (4.3%) were HIV-positive. Oral-fluid-based HIVST had sensitivity of 88.9% (95% CI: 65.3–98.6%) and specificity of 98.7% (95% CI: 97.1–99.6%), with no invalid results. Conclusions Offering both blood-based and oral-fluid-based HIVST resulted in high uptake when compared directly with provider-delivered testing. Both types of self-testing achieved high accuracy among users provided with a pre-test demonstration beforehand. Policymakers and donors need to adequately plan and budget for the sensitisation and support needed to optimise the introduction of new quality-assured blood-based HIVST products. |
| first_indexed | 2024-04-24T12:42:29Z |
| format | Article |
| id | doaj.art-4ad925911cdb4245b0b2a4698c1c3ee6 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-24T12:42:29Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-4ad925911cdb4245b0b2a4698c1c3ee62024-04-07T11:09:42ZengBMCBMC Infectious Diseases1471-23342024-04-0122S111210.1186/s12879-024-09231-1Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional studyAilva O’Reilly0Webster Mavhu1Melissa Neuman2Moses K. Kumwenda3Cheryl C. Johnson4George Sinjani5Pitchaya Indravudh6Augustin Choko7Karin Hatzold8Elizabeth L. Corbett9Malawi Liverpool Wellcome TrustCentre for Sexual Health and HIV/AIDS Research (CeSHHAR) ZimbabweDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical MedicineMalawi Liverpool Wellcome TrustGlobal HIV, Hepatitis and STI Programmes, World Health OrganizationMalawi Liverpool Wellcome TrustDepartment of Global Health and Development, London School of Hygiene & Tropical MedicineMalawi Liverpool Wellcome TrustPopulation Services InternationalMalawi Liverpool Wellcome TrustAbstract Background HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has largely been oral-fluid-based. We investigated whether users preferred blood-based (i.e. using blood sample derived from a finger prick) or oral fluid-based HIVST in rural and urban Malawi. Methods At clinics providing HIV testing services (n = 2 urban; n = 2 rural), participants completed a semi-structured questionnaire capturing sociodemographic data before choosing to test using oral-fluid-based HVST, blood-based HIVST or provider-delivered testing. They also completed a self-administered questionnaire afterwards, followed by a confirmatory test using the national algorithm then appropriate referral. We used simple and multivariable logistic regression to identify factors associated with preference for oral-fluid or blood-based HIVST. Results July to October 2018, N = 691 participants enrolled in this study. Given the choice, 98.4% (680/691) selected HIVST over provider-delivered testing. Of 680 opting for HIVST, 416 (61.2%) chose oral-fluid-based HIVST, 264 (38.8%) chose blood-based HIVST and 99.1% (674/680) reported their results appropriately. Self-testers who opted for blood-based HIVST were more likely to be male (50.3% men vs. 29.6% women, p < 0.001), attending an urban facility (43% urban vs. 34.6% rural, p = 0.025) and regular salary-earners (49.5% regular vs. 36.8% non-regular, p = 0.012). After adjustment, only sex was found to be associated with choice of self-test (adjusted OR 0.43 (95%CI: 0.3–0.61); p-value < 0.001). Among 264 reporting blood-based HIVST results, 11 (4.2%) were HIV-positive. Blood-based HIVST had sensitivity of 100% (95% CI: 71.5–100%) and specificity of 99.6% (95% CI: 97.6–100%), with 20 (7.6%) invalid results. Among 416 reporting oral-fluid-based HIVST results 18 (4.3%) were HIV-positive. Oral-fluid-based HIVST had sensitivity of 88.9% (95% CI: 65.3–98.6%) and specificity of 98.7% (95% CI: 97.1–99.6%), with no invalid results. Conclusions Offering both blood-based and oral-fluid-based HIVST resulted in high uptake when compared directly with provider-delivered testing. Both types of self-testing achieved high accuracy among users provided with a pre-test demonstration beforehand. Policymakers and donors need to adequately plan and budget for the sensitisation and support needed to optimise the introduction of new quality-assured blood-based HIVST products.https://doi.org/10.1186/s12879-024-09231-1HIVSelf-testingCross-sectional studyMalawiSub-Saharan AfricaMen |
| spellingShingle | Ailva O’Reilly Webster Mavhu Melissa Neuman Moses K. Kumwenda Cheryl C. Johnson George Sinjani Pitchaya Indravudh Augustin Choko Karin Hatzold Elizabeth L. Corbett Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study BMC Infectious Diseases HIV Self-testing Cross-sectional study Malawi Sub-Saharan Africa Men |
| title | Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study |
| title_full | Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study |
| title_fullStr | Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study |
| title_full_unstemmed | Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study |
| title_short | Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study |
| title_sort | accuracy of and preferences for blood based versus oral fluid based hiv self testing in malawi a cross sectional study |
| topic | HIV Self-testing Cross-sectional study Malawi Sub-Saharan Africa Men |
| url | https://doi.org/10.1186/s12879-024-09231-1 |
| work_keys_str_mv | AT ailvaoreilly accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT webstermavhu accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT melissaneuman accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT moseskkumwenda accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT cherylcjohnson accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT georgesinjani accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT pitchayaindravudh accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT augustinchoko accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT karinhatzold accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy AT elizabethlcorbett accuracyofandpreferencesforbloodbasedversusoralfluidbasedhivselftestinginmalawiacrosssectionalstudy |