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Acceptability, appropriateness, willingness to use, and perceptions towards HIV
self-testing among adolescent girls and young women in rural Northern Uganda: a
baseline formative cross-sectional study
#MMPMID41382191
Olum R
; Okello MO
; Kitutu FE
; Geng EH
; Musoke P
Implement Sci Commun
2025[Dec]; 6
(1
): 135
PMID41382191
show ga
BACKGROUND: Adolescent girls and young women (AGYW) in Uganda are at higher risk
for and bear a significant HIV burden, accounting for 25% of new infections.
Despite improved HIV testing services, AGYW in rural areas face barriers to
facility-based testing due to stigma, physical access barriers, and
confidentiality concerns. This study assessed the acceptability, appropriateness,
willingness to use, and perceptions of HIVST among AGYW in Northern Uganda.
METHODS: This cross-sectional study was part of a baseline assessment for a
quasi-experimental trial evaluating community-led HIVST among AGYW aged
15-24 years in 5 sub-counties in Omoro District. Data were collected using
systematic random sampling of households, with trained research assistants
administering structured questionnaires on tablets. The survey captured
demographic characteristics, sexual history, HIV knowledge, prior testing
practices, and attitudes toward HIVST. Factors influencing willingness to use
HIVST were analyzed using simple logistic regression in Stata 18.0. RESULTS:
Among 415 AGYW (median age 19 years, IQR 17-22), 23.1% had at least a secondary
education, 41.4% were married or cohabiting, and 16.9% had been in more than one
marriage or union. Sexual activity was reported by 74.2%, with a median age at
first intercourse of 16 years (IQR 15-18); 12.7% reported having multiple sexual
partners in the past year. Although 75.4% had been tested for HIV, only 28.0% had
heard of HIVST, and 17.5% of these had used it. More than two-thirds of the
participants found HIVST acceptable, appropriate, and feasible. Willingness to
use HIVST was high (93.0%), with preferences for blood-based (53.3%) and oral
fluid-based tests (46.3%). Willingness to use HIVST was associated with older age
(COR 1.19, 95% CI 1.03-1.37, p?=?0.017), ever having had sexual intercourse (COR
2.67, 95% CI 1.25-5.71, p?=?0.011), and prior HIV testing (COR 2.32, 95% CI
1.07-5.04, p?=?0.033). Preferred access points included government health
facilities (64.8%), community hotspots (57.8%), friends (33.3%), and CHWs
(21.9%). Over half (61.0%) desired additional support when testing, mainly from
health workers (69.6%) and friends (26.1%). Anticipated challenges included
interpretation results (57.1%), insufficient test usage information (53.7%), and
performing the test correctly (52.3%). CONCLUSION: Our findings indicate high
acceptability of HIVST among AGYW in rural northern Uganda, significantly higher
in older individuals, prior sexual activity, and prior HIV testing experience.
Targeted implementation strategies addressing knowledge gaps, providing
beneficiary support, and leveraging existing community structures could further
optimize HIVST uptake. Research on sustainable community-led models of HIVST
distribution will be critical to reaching underserved AGYW, reducing undiagnosed
HIV infections, and strengthening HIV prevention and care outcomes in this key
population.
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