Driving demand for HIV-ST among High-Risk Groups in India

PATH India is implementing STAR (HIV Self-Testing  in Africa) Initiative with the support of UNITAID through Population Service International (PSI). The introduction of HIV self-testing to India is intended

to help increase access to HIV self-testing due to the convenience and confidentiality that it offers.

The intervention, working closely with NACO and other community-based organizations, will work to implement a range of service delivery models utilizing HIVST kits provided by the project, resulting in an increased linkage to care, treatment, and prevention services for population groups and geographical pockets with high HIV vulnerability. To promote the uptake of the self-testing among the identified population in the rollout geographies,

we undertook a study to understand and provide recommendations for enablers and barriers

driving demand of HIV self-testing (HIV-ST) amongst high risk groups in India as well as feasibility and scalability of implementing HIV-ST in India

We used the human-centered design (HCD) process to conduct a qualitative study with respondents from high-risk groups (PwID, MSM, TGW, FSW). Enhancing the HCD process with behavioural science, we uncovered invisible problems and

understood respondents’ perceptions around access and use of HIV self-testing in particular and motivations, triggers, barriers from their experiences with existing HIV testing services.

We also engaged with key stakeholders to take feedback on the feasibility and scalability of different implementation

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A previous study supported by NACO found that HIVST is highly acceptable to KPs and therefore recommended, particularly for those populations that are hard-to-reach. 

However, to introduce HIV self-testing in the national program, it is important to design the user’s journey from being prompted to get a self-test kit to acting upon the result of the screening. This is also important since HIV-ST may have new fears and barriers and pose additional challenges to further linkages. Moreover, the communication methods and distribution channels for HIV self-testing may be different from those used for regular testing services. 

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We found an opportunity for HIV-ST to reduce the effect of stigma by minimising (duration of) interactions associated with HIV and reducing the inconvenience and opportunity cost of getting an HIV test. Respondents perceived additional fears of making an error while conducting a self-test and questioned the credibility of what seems to be an over-simplistic product for a deadly disease, especially for the oral kit. Moreover, many reactively compared the accuracy of self-testing with testing conducted at ICTCs.

The HCD process resulted in actionable insights that direct us towards designing a conducive ecosystem for self-testing. This may include prompts in the users’ environment (at hotspots for paid-sex and drug use, CBOs, pharmacies, and via community health providers, peer educators, partners) to remind the user to get a self-test kit, a help centre to get assistance over call or chat during testing, and steps to ask for support upon testing positive.

Here’s one example:

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Addressing Stigma Of Testing At Centre

‍How might we reduce stigma in asking for an HIV-ST kit?

‍Provide kits to users’ trusted providers so that they may ask their trusted provider to either courier the kit home or visit their home for an assisted test. 

Distribute self-test kits to everyone openly to position it as a norm instead of symptom dependent

Addressing Stigma And Inconvenience Of Visiting A Centre In A New City

How might we make it seem easier for the user to store or carry an HIV self-test kit?

Popularise HIV-ST kit as something to pack along for trips (much like sanitary pads). This will also make it seem easy & discrete to store.

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Addressing Perception Of Difficulty Of Conducting Self-Test

How might we make it seem easier for the user to conduct an HIV self-test?

Popularise testing as an easy & quick 3-5 step process, and emphasize the same on the instructions as well- using both graphics & words (with vernacular translation).

Video/ads can also be used to demonstrate a self-test. These must also clearly indicate any preparation & waiting period.

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Addressing Perception Of Inaccuracy Of An Oral Self-Test Kit

How might we make the oral HIV ST seem more credible?

Help the users understand the rationale of oral testing of antibodies to help them differentiate it from oral transmission of the virus.

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