Abstract
Globally, 36.7 million individuals live with HIV/AIDS, with 2.5 million new cases annually. Youth (14-25 years) account for 45% of these new infections. Those aged 15-24 years are less likely to be aware of their HIV status and engage in HIV care compared to older adults. This study explores the use of HIV self-testing to improve access to HIV care among Kenyatta University undergraduates.
To identify barriers and facilitators to HIV self-testing in this group.
Employing multistage cluster sampling, 398 students were surveyed using a self-administered questionnaire.
Of the participants (median age 21 years, 1:1.03 male-to-female ratio), 91.7% understood HIV's seriousness, with sexual intercourse as the primary transmission mode. Self-testing usage was 28.8%. Key barriers included fear of partner reaction, stigma, and lack of confidence. Significant facilitators were being female, knowledgeable about HIV, and sexually active.
Only 24% had prior HIV testing experience. The study highlights the importance of addressing fears and misconceptions while leveraging knowledge and sexual activity awareness to promote HIV self-testing.
Author Contributions
Copyright© 2024
Muendo Nicholas, et al.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests The authors have declared that no competing interests exist.
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Introduction
Globally, 36.7 million people live with HIV/AIDS, and annually, 2.5 million new infections are reported. Notably, 45% of these infections are among youth aged 14 to 25, with university students at high risk due to behaviour’s like cross-generational sexual relationships, escalating the spread of HIV/AIDS and other sexually transmitted diseases
Materials And Methods
The study, a cross-sectional descriptive analysis, was conducted at Kenyatta University's main campus in Nairobi, Kenya. This campus was selected for its diverse student population. A multi-stage cluster sampling method was used, selecting random clusters within faculties or schools. This approach was chosen to effectively represent the university's large and dispersed undergraduate population. The sample size, determined using Fischer's formula, was set at 398, accounting for a 95% confidence level, a 55% target characteristic proportion, and a 5% precision degree. Participants included undergraduates aged 18-25 years at the main campus, excluding those who were HIV positive and on treatment or taking end-of-semester/year exams. Data collection involved self-administered questionnaires with both open and closed questions, piloted at the Parklands campus.Data analysis was quantitative, focusing on descriptive analysis and quantitative methods to explore variable relationships
Results
The average age of the participants was 21.1 years, with a majority being single, female, Christian, full-time students majoring in Education, and living off-campus ( Participants demonstrated substantial knowledge about HIV, recognizing it as a serious disease primarily transmitted through sexual contact. Nearly half were informed about HIV pre-exposure prophylaxis, the lack of a definitive cure, and the possibility of living a normal life with Highly Active Antiretroviral Therapy (HAART), as detailed in ( Participants recognizing HIV/AIDS as serious and informed about pre-exposure prophylaxis, as well as those identifying as sexually active, were more inclined to use HIV self-testing ( Media exposure, notably the "Chukua Selfie" campaign, correlated with higher usage of HIV self-testing. Participants generally favored self-testing and would recommend it to others ( Comparing barriers and facilitators for HIV self-testing among undergraduates, most participants hadn't used it, and no significant statistical link was found between demographic factors (age, gender, marital status) and self-testing usage (
18 – 21
257
64.6
22 – 25
141
35.4
Male
196
49.2
Female
202
50.8
Single
390
98.0
Married
8
2.0
Christian
373
93.7
Muslim
25
6.3
Full time
391
98.2
Part time
7
1.8
In school
137
34.4
Out of school
261
65.6
Environmental Sciences
7
1.8
Business
71
17.8
Hospitality and Tourism
17
4.3
Nursing Sciences
6
1.5
Education
122
30.7
Engineering and Technology
6
1.5
Economics
29
7.3
Agriculture & Enterprise Development
6
1.5
Public Health and Applied Human Sciences
24
6.0
Pure and Applied Sciences
32
8.0
Medicine
7
1.8
Humanities and Social Sciences
40
10.1
Architecture
6
1.5
Creative, Film and Media Studies
17
4.3
Law
8
2.0
Yes
364
91.5
No
18
4.5
Unsure
16
4.0
Sexually
390
98.0
Mother to Child
349
87.7
Blood Transfusion
327
82.2
Intravenous Drug Abuse
180
45.2
Yes
190
47.7
No
160
40.2
Unsure
48
12.1
Yes
20
5.0
No
341
85.7
Unsure
37
9.3
Yes
316
79.4
No
28
7.0
Unsure
54
13.6
Yes
260
65.3
No
138
34.7
Yes
97
24.4
No
301
75.6
Last 3 months
69
26.5
Last 6 months
75
28.8
More than 1 year ago
116
44.6
Facility test (VCT)
185
71.2
HIV self-testing
75
28.8
INSTI
25
25.8
OraQuick
59
60.8
Atomo HIV self-test
13
13.4
Yes
278
69.8
No
120
30.2
Yes
228
57.3
No
50
12.6
Never had sex
120
30.2
Yes
189
47.5
No
209
52.5
Yes
97
100.0
18 – 21
60 (61.9)
197 (65.4)
22 – 25
37 (38.1)
104 (34.6)
1.2 (0.7 – 1.9)
0.520
Male
40 (41.2)
156 (51.8)
Female
57 (58.8)
145 (48.2)
1.5 (1.0 – 2.4)
0.071
Single
94 (96.9)
296 (98.3)
Married
3 (3.1)
5 (1.7)
1.9 (0.4 – 8.1)
0.390
KnowledgeaboutHIV
Yes
93 (95.9)
271 (90.0)
1.2 (0.4 – 3.7)
0.752
No
4 (4.1)
14 (4.7)
Reference
Unsure
0 (0.0)
16 (5.3)
-
Yes
64 (66.0)
126 (41.9)
3.4 (1.9 – 5.8)
No
21 (21.6)
139 (46.2)
Reference
Unsure
12 (12.4)
36 (12.0)
2.2 (1.0 – 4.9)
0.052
Yes
3 (3.1)
17 (5.6)
0.5 (0.1 – 1.7)
0.288
No
88 (90.7)
253 (84.1)
Reference
Unsure
6 (6.2)
31 (10.3)
0.6 (0.2 – 1.4)
0.205
Discussion
The study, mainly involving undergraduate students aged 18-21, may best represent this demographic. With almost equal gender representation, findings could apply to both males and females, echoing Hatzold et al.'s discovery of first-time testers among 16-24-year-olds The study revealed satisfactory HIV/AIDS knowledge among participants, contrasting a Malaysian study showing limited understanding of non-HIV STDs and alarming risky behaviors The study found participants generally had positive attitudes towards those living with HIV, though some harbored fears and misconceptions. Media, especially social media, effectively raised HIV self-testing (HIVST) awareness, echoing Birdthistle et al.'s findings on the impact of a multimedia campaign in South Africa The study showed 24% of participants had used HIV self-test kits, a moderate uptake akin to findings in Malawi and Zimbabwe among young people
Conclusion
The study highlighted barriers and facilitators to HIV self-testing among Kenyatta University undergraduates, offering insights for interventions to boost self-testing uptake and enhance HIV prevention and care. Key barriers included fear of positive results, access challenges, and HIV stigma, while positive attitudes and media exposure were facilitators. Strategies should focus on reducing stigma, increasing self-test kit accessibility and affordability, improving counseling services, and addressing gender disparities in testing. HIV self-testing is advised as a supplementary approach to facility-based testing, with a need to monitor its long-term effects on prevention and treatment.