WEAB023 – Insights Into Potential Users And Messaging For Hiv

Report
Insights into Potential Users and Messaging
for HIV Oral Self Test Kits in Kenya
Findings and Key Recommendations
2014
Ministry of Health
Study Objectives
Main objective: Inform the design and implementation of a
pilot project to increase the use of HIV oral self testing in
Kenya.
Specific objective:
– Determine likely users of oral HIV self test kits among the
General Population (GP) and Key Populations (KP) at risk in
urban and rural settings;
– Identify incentives for using oral HIV self test kits among the
GP and KP at risk in urban and rural settings;
– Identify and test key messages and approaches to increase
demand and use of oral HIV self-test kits.
Sample Size
Study location: Mombasa (urban setting) and Siaya, a rural district in
Nyanza province
Study Component
Quantitative
Household Structured Survey
Exit Interview at KP - Drop-inCenters/Clinics
Qualitative
Focus Group Discussions
(FGD)
Target Population
A total of 353 women and 429 men (18-49
years), in both Mombasa and Siaya
100 MSM and 100 FSW (18-49 years) at
drop-in centers of Mombasa
4 FGD’s of men and women 18-49 years
In-depth Interviews (IDI)
10 IDIs of men and 10 IDIs of women 18-49
years
10 IDIs of MSM and 10 IDIs of FSW 18-49
years
Message development and
pretest
300 men and women in Mombasa and Siaya
(GP and KP)
Findings
General Population
HIV Testing Behaviour (1)
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
Ever tested for HIV
81.4
94.1
87.7 (686)
Tested for HIV in past 12
months
65.3
76.7
71.0 (555)
Knows place to do HIV test
96.6
97.8
97.2 (692)
Public clinics/hospitals
54.9
63.2
59.3 (407)
Private clinics
26.7
15.3
20.6 (141)
HTC centers
20.4
11.7
15.7 (108)
Mobile clinics
19.1
35.2
27.7 (190)
Venue of last HIV test
HIV Testing Behaviour (2)
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
Attitudes toward HIV testing and abilities to handle test results
“I would be treated poorly by
health workers at HTC
center”: Agreed or strongly
agreed
16.8
20.0
18.1 (144)
“I am confident in coping with
test results”: Agreed or
strongly agreed
85.5
94.6
90.0 (782)
“I am confident that I can
reveal HIV status to partner”:
Agreed or strongly agreed
82.4
92.1
87.2 (682)
HIV Oral Self-testing: Perceptions (1)
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
Ever seen/heard of HIV test kit 4.9
5.6
5.2 (41)
Ever used HIV test kit
0.0
4.8
2.5 (1)
Would use if made available
94.6
97.4
96.0 (750)
Incentives for using HIV Oral self-test kit
Easy to use
64.2
57.1
60.6 (455)
Convenient to use
25.9
29.2
27.6 (207)
Confidentiality/privacy
52.8
46.3
49.5 (372)
Do not have to visit a HF
25.9
37.4
31.7 (238)
HIV Oral Self-testing: Perceptions (2)
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
Would seek confirmatory test
41.8
79.8
60.7
Would recommend test to
partner
90.3
94.8
92.5
How can HIV Oral Self-test be promoted in Kenya
Mass media
83.7
65.9
74.8
Brochures
6.1
9.2
7.7
Health workers
31.9
37.4
34.7
Community Health Outreach
workers
40.1
22.6
31.3
Others
4.1
36.7
20.3
HIV Oral Self-testing: Perceptions (3)
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
What would you do if the test kit was sold and the price was too high
Find free HTC services
80.1
78.2
79.2
Find cheaper HTC services
13.2
14.9
14.2
Not go for a test
6.4
6.9
6.7
If the price was the same as HTC, what would you choose?
Oral self testing
96.2
88.2
92.2
Traditional HTC
3.1
10.3
6.7
Mobile HTC
0.7
1.5
1.1
Further analysis show likely users among General
Population as:
 Ever tested for HIV
 Have support from spouse/sex partner to be tested for HIV
 Live in Mombasa (Urban)
 Note: Most other factors were not statistically significant,
mostly due to limited statistical power (due to having small #
of non-likely users).
Preferred retail/distribution outlets (by city)
Mombasa Siaya
%(n=392) %(n=390)
Total sample
%(N=782)
Public clinics
57.1
78.4
67.9
Private clinics
29.4
15.0
22.1
Private
pharmacies/chemists
Shops/super markets
81.4
42.6
61.2
24.5
25.0
24.8
Note: If we add private clinics and privates pharmacies
together, the private sector is the preferred channel: 83%
Preference to get kit from mentioned outlet
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
Confidentiality
41.0
7.9
24.3 (182)
Friendly
7.0
2.6
4.8 (36)
Services always available 0.3
3.7
2.0 (15)
Easy to access
49.9
76.8
63.5 (476)
Others
1.9
9.0
5.5 (41)
Factors Influencing the 2 Key Incentives to Use
Who chose the test for its ease of use?
•
•
•
Residents of Siaya (Rural)
Ever tested for HIV
Tested for HIV in the previous 12 months
Who chose the test for its confidentiality?
• Residents of Mombasa (Urban)
• Tested for HIV in the past 12 months
• Have higher education
• Could not reveal HIV status to partner/spouse
Messages General Population want to hear or see
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
Retail price
46.9
23.6
35.3
Retail outlet
15.6
8.2
11.9
Instructions how to use
56.1
69.7
62.9
Benefits
25.3
28.2
26.7
Advantages
24.0
22.6
23.3
Safety features
14.5
22.3
18.4
Referral services
9.2
4.6
6.9
From where/who GP want to see/hear about HIV Oral self-test kits
Mombasa
%(n=392)
Siaya
%(n=390)
Total sample
%(N=782)
Doctor
38.5
31.8
35.2
Nurse/Counselor
26.5
32.6
29.5
Television
53.6
22.3
38.0
Radio
51.0
Community health/outreach
worker
45.4
41.8
46.4
40.8
43.1
Pharmacist
6.7
9.1
11.5
Findings
Key Populations (FSW and MSM)
Demographics (1)
MSM
%(N=100)
FSWs
%(N=100)
Gender
Male
100
Female
100
Age
18-24 years
53
39
25-34 years
47
61
Primary or less*
69
44
Secondary
24
49
Tertiary
7
7
Education
HIV Oral Self-testing: Perceptions (1)
MSM
%(N=100)
FSWs
%(N=100)
Ever seen/heard of HIV test kit
47
8
Ever used HIV test kit
0
0
Would use if made available
57
98
Incentives for using HIV Oral self-test kit
Easy to use
70.2
52.0
Convenient to use
12.3
31.6
Confidentiality/privacy
68.4
70.4
Do not have to visit a HF
28.1
22.4
Saves time
21.1
9.2
HIV Oral Self-testing: Perceptions (2)
MSM
%(N=100)
FSWs
%(N=100)
Would seek confirmatory test
40
75
Would recommend test to partner
56
100
How can HIV Oral Self-test be promoted in Kenya
Mass media
43.0
58.0
Brochures
5.0
14.0
Health workers
55.6
30.0
Community Health Outreach workers
55.0
37.0
Others (Community sensitization, road
shows, seminars, churches/mosques)
23.0
31.0
HIV Oral Self-testing: Perceptions (3)
MSM
%(N=100)
FSWs
%(N=100)
What would you do if the test kit was sold and the price was too high
Find free HTC services
84.5
74.0
Find cheaper HTC services
3.4
9.0
Not going to test
3.0
If the price was the same as HTC, what would you choose?
Oral self testing
96.5
95.0
Traditional HTC
3.5
5.0
Preferred retail/distribution outlets (by city)
MSM
%(N=100)
FSWs
%(N=100)
Public clinics
Private clinics
Private pharmacies/chemists
47.4
8.8
49.1
53.1
7.1
74.5
Shops/super markets
NGOS
15.8
19.3
13.3
Other (Drop-in-centers,
clubs, bars & lodgings)
10.5
14.3
Note: If we add private clinics and privates pharmacies, we get
private sector as the preferred channel for both MSM and FSW
Why prefers to get kit from mentioned outlet
MSM
%(N=100)
FSWs
%(N=100)
Confidentiality
22.8
23.5
Friendly
12.3
17.3
Easy to access
59.6
44.9
Willingness to pay by age and education
MSM
%(N=57)
FSWs
%(N=94)
18.24 years
54.7
97.4
25-35 years
61.5
92.7
36-49 years
50.5
83.3
Primary or less*
30.8
95.5
Secondary
70.7
93.9
Tertiary
50.0
85.7
Age
Education
Messages Key Populations want to hear or see
MSM
%(N=100)
FSW
%(N=100)
Retail price
7.0
5.0
Retail outlet
2.0
3.0
Instructions how to use
34.0
66.0
Benefits
21.0
29.0
Advantages
14.0
33.0
Safety features
34.0
14.0
Referral services
14.0
3.0
From where/who KP want to see/hear about HIV Oral self-test kits
MSM
%(N=100)
FSW
%(N=100)
Doctor
Nurse/Counselor
Television
26.0
22.0
17.0
60.0
33.0
22.0
Radio
34.0
18.0
Community health/outreach Worker
17.0
37.0
Pharmacist
8.0
11.0
Street play
14.0
3.0
Brochure/Magazine
10.0
4.0
Post-Test Club
16.0
-
Conclusion and Recommendations (1)
 Self testing should be introduced for GP and KP. Interest
and intention to use overwhelmingly high especially for GP
and FSW
 Targeted communication on disclosure of test status to
sex partner or health care provider and safe sex practices
 Further HIV self testing programs to address self-efficacy
issues
 More efforts to reach never testers or those who tested
less frequently as they indicated lower intention to use
 The most frequent intentions to use: ease of use,
convenience, don’t have to travel to HF and privacy
Conclusion and Recommendations (2)
 HIV self testing preferred to be introduced through private
and public sector (public clinics, pharmacies/chemist and
private clinics)
 Health care providers and community health workers are
the most preferred sources for promoting oral self testing
 Both TV and radio demonstrate potential for messaging
channels for raising awareness and demand
 Kiswahili is the most preferred language for radio
advertisement
 TV appears to be more effective than radio in helping
viewers recall the key messages
 Answers to frequently asked questions are important

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