Feasibility and Preferences for Home-based Self-Testing for HIV, Diabetes, and Hypertension in Kenya, South Africa, and Zambia

Home-based self-testing may improve individual health outcomes and public health disease surveillance by lowering the barriers associated with clinic-based diagnostic testing in low- and middle-income countries (LMICs). We assessed the feasibility of conducting home-based, self-testing for key communicable and non-communicable diseases, including HIV, diabetes, and hypertension, in sub-Saharan Africa. We enrolled participants ([greater double equals]15 years) from households in peri-urban and rural communities of Kenya, South Africa, and Zambia. Participants opted in to self-directed rapid 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 rapid 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 in each 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) tested positive for HIV and 4% (N=18) had high blood glucose, while 26% (N=131) had high blood pressure measured by the clinical team. Only 13% of study participants reported previously using a rapid test. Most (>90%) participants rated all procedures for HIV and blood glucose tests as either "very easy" or "fairly easy" to use. Most participants (88%, N=458) preferred home-based testing. Home-based self-testing for HIV and blood glucose and testing for blood pressure were feasible and preferred in peri-urban and rural areas of Kenya, South Africa, and Zambia. Self-testing has potential to expand and accelerate access to healthcare delivery in LMICs.