Acceptability of HIV self-testing among HIV high-risk Adolescent Girls and Young Women (AGYW) in urban settings in Uganda

Adolescent Girls and Young Women (AGYW) bear a disproportionate burden of HIV in Sub-Saharan Africa, but HIV testing in this sub-population is sub-optimal. HIV self-testing (HIVST) is an evidence-based intervention that has been shown to improve testing rates among AGYW; however, its acceptability in this sub-population remains under-explored. We assessed the acceptability of HIVST and associated factors among HIV high-risk AGYW. We enrolled HIV high-risk AGYW consecutively from Kampala and Wakiso districts in a community-based cross-sectional study. A structured questionnaire was used to collect data. Acceptability was defined as willingness to use HIVST services if provided, and was measured as a composite outcome using the seven constructs of the Theoretical Framework of Acceptability (TFA) where each construct was assessed using one 5-level Likert item question weighted 1-5. The sum of scores was computed and participants with a score >21 was regarded as accepting HIVST. Descriptive statistics were used to summarize the data and a mixed effects modified Poisson was used to assess factors associated with acceptability of HIVST. Between December 2024 and May 2025, 377 HIV high-risk AGYW of mean age 19.7 years (standard deviation (SD): 2.7) were enrolled in the study of which 55.2% reported having a sexually transmitted infection in the past six months. The acceptability of HIVST was 90.2% (95%CI: 86.7, 92.8). Adjusted analysis showed that having multiple sexual partners, consistent condom use, no history of sexual violence and PrEP use in the past six months, and HIV testing in the past 12 months were significantly associated with greater willingness to use HIVST. HIVST is highly acceptable among the AGYW studied, and this presents a potential opportunity that can be leveraged to scale-up HIVST services. Future implementation efforts could consider strategies that address both behavioral risks and psychological vulnerabilities to optimize uptake and impact of HIVST.