Research ArticleOriginal Research

Exploring HIV Self-Testing: Barriers and Facilitators Among Undergraduate Students in Nairobi, Kenya

Nicholas Kyalo Muendo, Joseph Thigiti, Osborn Tembu, Abdinoor Mohamed, Stephanie Audi and Muthoni Karanja
The Annals of Family Medicine November 2024, 22 (6) 502-508; DOI: https://doi.org/10.1370/afm.3169

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  • Table 1.

    Sociodemographic Characteristics of Study Participants (N = 398)

    CharacteristicNo. (%)
    Age group, y
        18-21257 (64.6)
        22-25141 (35.4)
    Gender
        Female202 (50.8)
        Male196 (49.2)
    Marital status
        Single390 (98.0)
        Married8 (2.0)
    Religion
        Christian373 (93.7)
        Muslim25 (6.3)
    Mode of study
        Full time391 (98.2)
        Part time7 (1.8)
    Residency status
        In school137 (34.4)
        Out of school261 (65.6)
    School
        Education122 (30.7)
        Business71 (17.8)
        Humanities and Social Sciences40 (10.1)
        Pure and Applied Sciences32 (8.0)
        Economics29 (7.3)
        Public Health and Applied Human Sciences24 (6.0)
        Creative, Film, and Media Studies17 (4.3)
        Hospitality and Tourism17 (4.3)
        Law8 (2.0)
        Environmental Sciences7 (1.8)
        Medicine7 (1.8)
        Agriculture and Enterprise Development6 (1.5)
        Architecture6 (1.5)
        Engineering and Technology6 (1.5)
        Nursing Sciences6 (1.5)
  • Table 2.

    HIV Self-Testing Characteristics of Study Participants

    CharacteristicNo. (%)
    Ever tested for HIV (N = 398)
        Yes260 (65.3)
        No138 (34.7)
    Ever used HIV self-test kit (N = 398)
        Yes97 (24.4)
        No301 (75.6)
    HIV self-test used (n = 97)
        INSTI25 (25.8)
        OraQuick59 (60.8)
        Atomo Diagnostics HIV Self-Test13 (13.4)
    Last time tested for HIV (n = 260)
        Within 3 months69 (26.5)
        Within 6 months75 (28.8)
        >1 year116 (44.6)
    Type of test done at that time (n = 260)
        Facility test (VCT)185 (71.2)
        HIV self-testing75 (28.8)

    • VCT = voluntary counseling and testing.

  • Table 3.

    Barriers to Use of HIV Self-Testing

    BarrierNo. (%)
    Knowledge about HIV (N = 398)
    HIV/AIDS is a serious disease
        Yes364 (91.5)
        No18 (4.5)
        Unsure16 (4.0)
    How HIV is spread
        Sexually390 (98.0)
        Mother to child349 (87.7)
        Blood transfusion327 (82.2)
        Intravenous drug use180 (45.2)
    Aware of preexposure prophylaxis
        Yes190 (47.7)
        No160 (40.2)
        Unsure48 (12.1)
    HIV has a cure
        Yes20 (5.0)
        No341 (85.7)
        Unsure37 (9.3)
    Live normal life with HAART
        Yes316 (79.4)
        No28 (7.0)
        Unsure54 (13.6)
    HIV testing acceptance
    Ever tested for HIV (N = 398)
        Yes260 (65.3)
        No138 (34.7)
    Ever used HIV self-test kit (N = 398)
        Yes97 (24.4)
        No301 (75.6)
    Last time tested for HIV (n = 260)
        Within 3 months69 (26.5)
        Within 6 months75 (28.8)
        >1 year116 (44.6)
    Type of test done at that time (n = 260)
        Facility test (VCT)185 (71.2)
        HIV self-testing75 (28.8)
        HIV self-test used (n = 97)
        INSTI25 (25.8)
        OraQuick59 (60.8)
        Atomo Diagnostics HIV Self-Test13 (13.4)

    • HAART = highly active antiretroviral therapy; VCT = voluntary counseling and testing.

  • Table 4.

    Facilitators to Use of HIV Self-Testing

    FacilitatorNo. (%)
    Acceptability of HIV self-testing (n = 97)
    Preferred HIV self-test kit
        Blood72 (74.2)
        Oral22 (22.7)
        None3 (3.1)
    Instructions on kit easily understood
        Yes84 (86.6)
        No13 (13.4)
    Know difference between facility testing (VCT) and HIV self-testing services
        Yes75 (77.3)
        No22 (22.7)
    Preference for HIV testing
        Health facility53 (54.6)
        Privately at home44 (45.4)
    Easily accessed HIV self-test kits
        Yes64 (66.0)
        No33 (34.0)
    Sexual behavior factors
    Ever had sex (N = 398)
        Yes278 (69.8)
        No120 (30.2)
    Consider self sexually active (N = 398)
        Yes228 (57.3)
        No50 (12.6)
        Never had sex120 (30.2)
    Recommendation of HIV self-testing and its media campaign
    Know about campaign dubbed “Chukua Selfie” (N = 398)
        Yes189 (47.5)
        No209 (52.5)
    Recommend HIV self-testing (n = 97)
        Yes97 (100.0)

    • VCT = voluntary counseling and testing.

  • Table 5.

    Comparing Barriers and Facilitators to Uptake of HIV Self-Testing Services

    Ever Used (n = 97), No. (%)Never Used (n = 301), No. (%)Odds Ratio (95% CI)P Value
    Barriers to use of HIV self-testing
    Age, y
        18-2160 (61.9)197 (65.4)ref
        22-2537 (38.1)104 (34.6)1.2 (0.7-1.9).520
    Gender
        Male40 (41.2)156 (51.8)ref
        Female57 (58.8)145 (48.2)1.5 (1.0-2.4).071
    Marital status
        Single94 (96.9)296 (98.3)ref
        Married3 (3.1)5 (1.7)1.9 (0.4-8.1).390
    Facilitators to use of HIV self-testing
    Knowledge about HIV
      HIV/AIDS is a serious disease
        Yes93 (95.9)271 (90.0)1.2 (0.4-3.7).752
        No4 (4.1)14 (4.7)ref
        Unsure0 (0)16 (5.3)na
    Aware of HIV preexposure prophylaxis
        Yes64 (66.0)126 (41.9)3.4 (1.9-5.8)<.001
        No21 (21.6)139 (46.2)ref
        Unsure12 (12.4)36 (12.0)2.2 (1.0-4.9).052
    HIV has a cure
        Yes3 (3.1)17 (5.6)0.5 (0.1-1.7).288
        No88 (90.7)253 (84.1)ref
        Unsure6 (6.2)31 (10.3)0.6 (0.2-1.4).205

    • na = not applicable; ref = reference.

Additional Files

  • VISUAL ABSTRACT IN PDF FILE BELOW

  • PLAIN-LANGUAGE ARTICLE SUMMARY AND VISUAL ABSTRACT

    Original Research

    Fear of Positive Results and Stigma Hinder HIV Self-Testing, While Routine Use and Protecting Loved Ones Motivates University Students 

    Background and Goal:HIV remains a global health challenge, with over 36.9 million individuals living with HIV in 2017. Despite efforts to increase HIV testing and treatment, traditional services have not effectively reached marginalized communities. HIV self-testing (HIVST) offers a discreet and accessible alternative, potentially improving testing rates among at-risk populations, including university students in Kenya. This study assessed the awareness and acceptance of HIVST among undergraduate students.

    Study Approach:This cross-sectional analytical study employed a multi-stage cluster sampling technique among undergraduate students aged 18-21 years at Kenyatta University. Clusters from various academic departments were randomly selected, and individual students were chosen for participation until the desired sample size of 398 participants was reached. Data were collected through questionnaires administered by trained enumerators.

    Main Results: Participants’ age averaged 21.1 years, with a majority being single, female, and full-time students.

    • Substantial HIV knowledge was observed, and nearly half were aware of pre-exposure prophylaxis (47.7%).

    • The majority of students have tested for HIV (65.3%), with a majority not using a self-test kit (75.6%).

    • Only 24.4% of students used a self test kit.

    • 45.4% of students said they would prefer to use a self-test kit rather than go to a facility.

    • Fear of positive results and stigma were primary barriers for self testing, while motivations for self-testing included routine use and protecting loved ones. 

    • Media exposure, especially the "Chukua Selfie" campaign, correlated with higher HIVST usage.

    Why It Matters: Participants' substantial knowledge of HIV contrasts with findings from other regions, underscoring the need for targeted education and safe sex promotion. Addressing fear and stigma through comprehensive interventions is essential for improving HIVST uptake. Integrating HIV self-testing into existing prevention programs can enhance HIV care frameworks in East Africa. Strategies to destigmatize HIV, ensure privacy in testing, and address misconceptions are vital for improving health outcomes among young individuals. Continuous efforts to strengthen self-testing programs are crucial to achieving global HIV targets.

    Exploring HIV Self-Testing: Barriers and Facilitators Among Undergraduate Students in Nairobi, Kenya

    Nicholas Kyalo Muendo, MBChB, MSc, MMed, et al

    Department of Family Medicine, Kenyatta University, Nairobi, Kenya

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