Self-Implemented HIV Testing: Perspectives on implementation by African American Youth and Service Providers

HIV/STI testing is a key element in the CDC’s effort to identify and treat infected persons. African American youth (16-24 yrs.) are at risk for HIV and other STIs, and confront numerous barriers to clinic-based HIV testing (e.g., stigmatization, confidentiality concerns). These barriers can be addressed by HIV self-implemented testing (SIT). We conducted formative interview (N = 49, age 15-17) and focus group (N = 5 groups) studies with low SES at-risk African American youth in San Francisco and Chicago, and providers of health and social services to youth in those cities (N = 4 groups; N = 5 interviews). Study questions yielded information on potential SIT consumers’ and disseminators’ perceptions of the concept and value of SITs vs. venue/clinic testing. In addition, test specific information was gathered on perceptions of the OraQuick SIT’s procedures and training materials, test result validity, retail costs, linkage-to-care and emotional consequences of SITs, and the value of SITs for repeat and partner testing. Both youth and providers perceive advantages to SIT use vs. clinic testing in terms of reducing social stigma and privacy concerns, and increasing convenience that, in turn, are expected to increase initial, repeat, and partner testing. Nevertheless, participants raised a number of caveats. A major concern was that those testing positive would not follow through for confirmatory testing or treatment and/or may experience adverse psychological outcomes without an “onsite” support person. In some instances, there were misperceptions that lead to negative attributions. For instance, some participants saw SITs as a confirmatory test rather than as a screening test that requires confirmatory testing to verify positive results. With regard to OraQuick, a number of specific barriers were identified including the high retail cost (> $40/unit in pharmacies), packaging concerns (e.g., seals that when removed destroy box instructions), as well as instructional and procedural challenges that reflect poor program fit with some young low SES African American consumers in terms of cognitive abilities (e.g., comprehension of technical language and complex instructions), socio-cultural factors (e.g., instructional video that appears to be a poor fit in terms of socio-economic status), and emotional expectations of consumers (e.g., video actor appears too calm). Overall, SITs, OraQuick in particular, have many desirable features, additional translation research may be justified to examine the concerns raised by these participants.