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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study

Authors: C. Dodds, E. Mugweni, G. Phillips, C. Park, I. Young, F. Fakoya, S. Wayal, L. McDaid, M. Sachikonye, J. Chwaula, P. Flowers, F. Burns

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Increasing routine HIV testing among key populations is a public health imperative, so improving access to acceptable testing options for those in need is a priority. Despite increasing targeted distribution and uptake of HIV self-sampling kits (SSKs) among men who have sex with men in the UK, little is known about why targeted SSK interventions for black African users are not as wide-spread or well-used. This paper addresses this key gap, offering insight into why some groups may be less likely than others to adopt certain types of SSK interventions in particular contexts. These data were collected during the development phase of a larger study to explore the feasibility and acceptability of targeted distribution of SSKs to black African people.

Methods

We undertook 6 focus groups with members of the public who self-identified as black African (n = 48), 6 groups with specialists providing HIV and social services to black African people (n = 53), and interviews with HIV specialist consultants and policy-makers (n = 9). Framework analysis was undertaken, using inductive and deductive analysis to develop and check themes.

Results

We found three valuable components of targeted SSK interventions for this population: the use of settings and technologies that increase choice and autonomy; targeted offers of HIV testing that preserve privacy and do not exacerbate HIV stigma; and ensuring that the specific kit being used (in this case, the TINY vial) is perceived as simple and reliable.

Conclusions

This unique and rigorous research offers insights into participants’ views on SSK interventions, offering key considerations when targeting this population.. Given the plethora of HIV testing options, our work demonstrates that those commissioning and delivering SSK interventions will need to clarify (for users and providers) how each kit type and intervention design adds value. Most significantly, these findings demonstrate that without a strong locus of control over their own circumstances and personal information, black African people are less likely to feel that they can pursue an HIV test that is safe and secure. Thus, where profound social inequalities persist, so will inequalities in HIV testing uptake – by any means.
Appendix
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Footnotes
1
The term ‘Black African’ appears as an ethnic category in the UK Census, and is widely used in UK epidemiological contexts to denote those who are part of the sub-Saharan African diaspora. It can be used to refer to people who have themselves migrated from this region, or whose predecessors have done so. This is also a highly contested and imprecise term, as it relates at one and the same time to self-identification as well as external-identification of racial/regional categories which are far from straightforward, and which also intersect with nationalities as well as linguistic and cultural groupings.
 
2
HIV SSKs are designed for users to take their own sample and then post it to the laboratory themselves. Results are then usually communicated to the user via either SMS text (where results are negative) or by a phone call (where there was an insufficient sample or a reactive result). In UK settings, clinical governance over laboratory procedures, and results communication is overseen by those working in expert clinical settings, and where a sample is reactive, sufficient information is given to the user to encourage them to attend their nearest clinic as soon as possible for confirmatory venous sample testing. While HIV SSKs can use either blood or oral fluids, only the blood based TINY vial and associated laboratory assay is CE Marked for approved use in the UK; also no oral SSK is currently able to provide 4th generation testing as recommended by the British HIV Association guidelines.
 
4
Given that there is currently no CE marked saliva-based HIV assay available in the UK, the study team was not permitted this type of ‘off label’ use.
 
5
CD, EM, SW, CP, GP and IY (all female Research Fellows / Lecturers with PhDs in medical sociology, social epidemiology or allied disciplines) conducted the data collection. All have considerable experience and training in the collection, management and analysis of qualitative data. Most members of the team also had considerable experience in the HIV field.
 
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Metadata
Title
Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study
Authors
C. Dodds
E. Mugweni
G. Phillips
C. Park
I. Young
F. Fakoya
S. Wayal
L. McDaid
M. Sachikonye
J. Chwaula
P. Flowers
F. Burns
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5256-5

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