Willingness and comfort to distribute HIV self-testing kits among people living with HIV in Bhutan: a cross-sectional study

Partner testing among people living with HIV is critical for HIV case detection but faces socio-cultural barriers. HIV self-testing (HIVST) remains underutilised in partner notification services (PNS). We examined factors associated with willingness and comfort to distribute HIVST. A cross-sectional study was conducted in Bhutan. Socio-demographic and behavioural characteristics were collected. Descriptive statistics and multivariable logistic regression assessed willingness and comfort in HIVST distribution. Among 377 adults, 72.2% aged 35-64 years, 59.9% were married. HIVST awareness (38.7%) and prior HIVST use (13.3%) were low. 53.1% were willing to distribute HIVST, with greater comfort towards spouses (66.0%) than non-spousal partners (21.0-40.1%). Willingness was associated with HIVST awareness (AOR = 2.40; 95% CI: 1.19-4.83) and valuing disclosure (AOR = 2.55; 95% CI: 1.11-5.84), while indirect distribution was associated with lower willingness (AOR = 0.13; 95% CI: 0.06-0.28) and comfort (AOR = 0.03; 95% CI: 0.01-0.15). Lower comfort was associated with social stigma (AOR = 0.13; 95% CI: 0.07-0.25) and being previously married (AOR = 0.25; 95% CI: 0.13-0.47), whereas healthcare discrimination was associated with greater comfort. Willingness and comfort are distinct but complementary constructs shaping index-based HIVST distribution within PNS. Strategies addressing stigma, disclosure, and partner type may improve partner testing.