“I would like to be part of the team distributing the kits because I have all the qualities” Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among young people and adult men in Kasensero fishing community, Rakai, Uganda

Abstract

Abstract; Background Despite efforts to improve HIV testing and linkage to HIV care among young people and adult men, uptake rates remain below global targets. We conducted formative research to generate data necessary to inform the design of a peer-led HIV self-testing (HIVST) intervention intended to improve HIV testing uptake and linkage to HIV care among young people and adult men in Kasensero fishing community in rural Uganda. Methods This was a cross-sectional, qualitative study conducted in three study communities in Kasensero fishing community in Rakai district, Uganda, between May 6 – 10, 2019. Six single-sex focus group discussions (FGDs) comprising 7-8 participants were conducted with young men (15-24 years), young women (15-24 years) and adult men (25+ years). We collected data on people’s perceptions about HIVST and peer-led HIVST; potential acceptability of peer-led HIVST and suggestions on how to implement peer-led HIVST in the community. Peer-led HIVST was defined as an approach that uses a trained lay person to distribute HIVST kits to other people in the community. FGDs were audio-recorded with permission from the participants, transcribed verbatim and analysed manually following a thematic framework approach. Results Forty-seven participants (31 men and 16 women) participated in the FGDs. Across communities and age-groups, most participants mentioned that peer-led HIVST would be generally acceptable to people in the community but people will need support in performing the test due to fear of performing the test wrongly or failing to cope with HIV-positive results. Most participants felt that peer-led HIVST would bring HIV testing services closer to the community “because [the peer-leader] could be my immediate neighbour”, making it easier for people to obtain the kits at any time of their convenience as opposed to placing them at a health facility. Participants suggested that the peer-leader should be a permanent resident, accessible, trustworthy, and good at keeping secrets. Conclusion Our study shows that peer-led HIVST is potentially acceptable in the fishing community suggesting that this approach can help to improve uptake of HIV testing services among young people and adult men who are usually missed through conventional HIV testing services.