Is HIV self-testing a strategy to increase repeat testing among pregnant and postpartum women? A pilot mixed methods study.

INTRODUCTION: Repeat HIV testing among pregnant and postpartum women enables incident HIV infection identification for targeted interventions. We evaluated oral HIV self-testing (HIVST) for repeat HIV testing among pregnant and postpartum women attending busy public clinics in East Africa. METHODS: Between October 2018, and January 2019, we conducted a mixed methods pilot to evaluate the acceptability of oral based HIVST among pregnant and postpartum women within three public health facilities in Kisumu, Kenya. We invited 400 seronegative pregnant and postpartum women to choose between clinic-based oral HIVST and the standard finger prick provider-initiated testing and counselling for repeat HIV testing. We measured the frequency of each choice and described the participants' experiences with the choices, including data from three focus group discussions. RESULTS: Slightly over half of women (53.8%, 95% confidence interval (CI): 48.7, 58.7) chose oral HIVST. Unmarried women were more likely to use HIVST (prevalence ratio (PR): 1.26, 95% CI: 1.01, 1.57, p<0.05). The most frequent reason for oral HIVST selection was fear of the needle prick (101/215, 47.0%). More HIVST than PITC users indicated lack of pain (99.1% vs 34.6%, p <0.001) and need for assistance (18.1% vs 1.1%, p<0.001) as reflective of their HIV testing experiences. Participants choosing HIVST cited privacy, ease and speed of procedure as the main reasons for their preference. CONCLUSIONS: The use of HIVST in Kenyan antenatal and postpartum settings appears to be feasible and acceptable for repeat HIV testing. Future work should explore the practical mechanisms for implementing such a strategy.