Knowledge and Willingness to Use HIV Self-Testing Among Health Facility Clients in La-Nkwantanang, Madina.

Abstract

Background: HIV remains a significant global public health threat, with Sub-Saharan Africa bearing the burden of over 25 million cases. Despite various efforts, testing rates remain suboptimal, particularly among marginalized groups who face structural barriers such as stigma, concerns about confidentiality, and limited access to healthcare facilities. HIV self-testing (HIVST) has emerged as an innovative, decentralized approach that allows individuals to conduct private and convenient screenings. This method aims to overcome the obstacles associated with traditional facility-based testing. However, uncertainties regarding distribution methods, potential social harms, effective linkage to care, and quality assurance have hindered the large-scale implementation of HIVST. Objective: The main objective of this study was to determine knowledge and willingness to utilize HIV self-testing among healthcare providers and their clients in La-Nkwantanang Madina Municipality, Ghana. Methodology: This study employed a mixed methods research design to determine knowledge and willingness to utilize HIV self-testing among health facility clients in La-Nkwantanang Municipality of Madina, Ghana. The quantitative part employed a cross-sectional survey administered among 390 outpatients of Madina Polyclinics (Rawlings Circle and Kekele). For the qualitative part, an in-depth interview was conducted among 9 healthcare providers (including ART Nurses, Laboratory Scientists, Dieticians, and General Nurses) from the two Polyclinics. Knowledge of HIV self-testing was assessed using 11 items covering legality, availability, testing methods, interpretation of results, confirmatory testing, and counseling. Scores were categorized as low (<50%), moderate (50–75%), or high (>75%) knowledge.. Chi-square tests were utilized to examine associations between each independent variable and the outcome. The level of significance was set at a p-value of 0.05, and the Confidence Interval (CI) was established at 95%. Adjusted odds ratios (AOR) were used to report the strengths of the associations. Thematic analysis was conducted on the qualitative data to explore the healthcare providers' perspectives on implementing the HIVST. Results: Among the 390 clients surveyed, 39.2% (153) were aware of HIV self-testing (HIVST), 49% had moderate knowledge, and 10% had high knowledge of HIVST. Most of the respondents (77.7%, n=303) expressed a willingness to use HIVST, and 69.0% (n=269) were willing to pay for the kit. Respondents aged 45 years and above were less willing than younger clients (AOR: 0.41; 95% CI: 0.18-0.94, p = 0.036). Higher levels of education increased willingness, with participants having basic (AOR: 3.59, 95% CI: 1.11-11.60, p = 0.033), secondary, vocational, or technical education (AOR: 5.47, 95% CI: 1.82-16.42, p = 0.002), and tertiary education (AOR:7.33, 95% CI: 2.15-25.03, p = 0.001) being more willing compared those with no formal education. Similarly, higher income (1600-2000 Ghana Cedis) was associated with increased willingness compared to lower income groups (AOR: 4.07, 95% CI: 1.05-15.83, p = 0.043) Sexual behavioural factors also played a role. Age at first sex was significantly associated with willingness to use HIVST. Respondents with sexual debut at 25 years or older were less willing to use HIVST compared to those aged 15-19 years (AOR: 0.22, 95% CI: 0.08-0.56, p = 0.002). Clients who ever had sex with a stranger (AOR: 2.52, 95% CI: 1.00-6.32, p = 0.049), ever had sex under the influence of alcohol (AOR: 2.40, 95% CI: 1.03-5.55, p = 0.041), had sex in exchange for money or gift (AOR: 2.70, 95% CI: 1.03-7.11, p = 0.043) were more willing to use HIVST compared to those who did not. Perceptions of the kit also influenced willingness. Those who found the kits credible (AOR: 2.09, 95% CI: 1.06-0.411, p = 0.033), safe to use (AOR: 5.18, 95% CI: 2.27-11.83, p <0.001), convenient to use (AOR: 2.54, 95% CI: 1.02-3.36, p = 0.045), easy to use (AOR: 4.39, 95% CI: 2.02-9.52, p <0.001), accessible (AOR: 3.48, 95% CI: 1.19-3.99, p <0.001) were more willing to use it. Also, fear of stigma or discrimination in purchasing kits reduced willingness (AOR: 0.36, 95% CI: 0.21 0.62, p <0.001). Discussion of HIV with others positively influenced willingness (AOR: 3.48, 95% CI: 1.19-3.99, p <0.001). Healthcare providers identified key barriers to HIVST implementation, including resource and logistical challenges, tracking of results, linkage to care, affordability, accessibility, literacy, and healthcare worker motivations. Conclusion: The findings highlight a high level of willingness to use HIVST among clients, influenced by sociodemographic, behavioural, and perceptual factors. Targeted interventions addressing educational disparities, income inequalities, and stigma concerns could enhance uptake. Addressing barriers identified by healthcare providers, such as resource limitations, accessibility, and linkage to care is crucial for the successful implementation of HIVST services in La Nkwantanang Madina Municipality. These insights are critical for policymakers and healthcare planners in designing effective strategies to promote HIVST adoption and integration into existing healthcare systems.