Acceptability and usability of home-based HIV and blood glucose self-testing and home-based blood pressure measurement in Kenya, South Africa, and Zambia

Home-based self-testing may improve individual health outcomes and public health programs by lowering barriers associated with clinic-based testing in low- and middle-income countries (LMICs). We assessed the acceptability and usability of conducting home-based self-testing for HIV and blood glucose and home-based researcher-conducted testing for blood pressure in sub-Saharan Africa. We enrolled participants (≥15 years old) from households in peri-urban and rural communities of Kenya, South Africa, and Zambia. Participants opted in to self-directed testing for HIV and blood glucose and had their blood pressure measured by a research team member. Our primary measures included HIV status and testing history, HIV and blood glucose test results, blood pressure, self-reported usability and acceptability of self-testing, and participant preferences for future self-testing. Among the 526 participants from 100 households enrolled per country, the average age was 41 years and 63% were female. Overall, 16% of participants reported living with HIV. Over half of participants (52%) had last tested for HIV > 12 months ago or had never tested for HIV, and 8% of participants were unsure of their HIV status. Among participants who self-tested, 2% (n = 6/330) tested positive for HIV and 4% (n = 18/469) had high blood glucose, while 26% (n = 131/502) had high blood pressure measured by the study team. Only 14% of study participants reported previous self-testing. Most (>90%) participants who self-tested rated all procedures for HIV and blood glucose tests as either “very easy” or “fairly easy” to use. Most participants (87%, n = 458/526) preferred home-based testing. Home-based self-testing for HIV and blood glucose and home-based blood pressure measurement were acceptable, usable and preferred in peri-urban and rural areas of Kenya and South Africa; findings from Zambia suggest promise for home-based testing but were limited by staff-administered HIV tests. Self-testing has the potential to expand and accelerate access to healthcare delivery in LMICs.