Uptake of oral-based HIV self-testing among Key Populations taking HIV pre-exposure prophylaxis in central Uganda

Abstract Introduction: HIV incidence is higher among key populations such as sex workers, fishermen and men who have sex with men. HIV self-testing among key populations taking HIV Pre-Exposure Prophylaxis has not been studied in Uganda yet it could be an alternative testing approach for these population categories. We assessed the uptake of oral based HIV self-testing among key populations enrolled on Pre-Exposure Prophylaxis in Uganda. Methods : A mixed methods cross-sectional study was conducted on 366 key populations attending Pre-Exposure Prophylaxis clinics at MARPI Mulago and Kasensero HC II Uganda, during May-August 2018. Respondents aged 15 years and above with no prior history of HIV self-testing were issued with “Oraquick” HIV rapid diagnostic test (kit) for self-testing. Data were collected using an interviewer administered structured questionnaire and through in depth interviews of selected respondents. A chi square test was performed to determine association between socio demographic, economic factors and propensity to uptake HIV self-testing. Logistic regression was used to determine the predictors of HIV self-testing uptake. Thematic analysis was performed to explore factors that promote and inhibit HIV self-testing uptake. Results : HIV self-testing acceptability was 100% (365/365) with 73% (n=265) of respondents willing to pay for a kit. Of these, 85%(n=227) would pay not more than 1.4USD. Sixty-six percent (n=243) of respondents had high propensity to uptake HIV self-testing. Predictors of uptake were clinic location (rural vs urban) (aOR = 17.63 95% CI 8.44 – 36.81, p<0.001); Key Population category (female sex worker’s vs others) aOR= 4.36 (95% CI: 1.63 – 11.66, p=0.003) and education level ( < primary vs post primary) aOR=0.38 (95% CI: 0.20 – 0.73). Using an oral fluid based kit “Oraquick” was reported to be free of pain, convenient, easy to use and time saving. A multimodal approach to distributing HIV self-testing kits was suggested by respondents. Conclusion HIV self-testing can be an alternative to the conventional routine 3 monthly follow up HIV screening for key populations on Pre-Exposure Prophylaxis. Kits’ distribution may employ several models. Majority of key populations would afford the kits at a cost not more than 1.4USD.