‘Bringing testing closer to you’: barriers and facilitators in implementing HIV self-testing among Filipino men-having-sex-with-men and transgender women in National Capital Region (NCR), Philippines – a qualitative study

  1. Jeanno Lorenz G Dinglasan
  2. John Danvic T Rosadiño
  3. Ronivin G Pagtakhan
  4. Denis P Cruz
  5. Matthew T Briñes
  6. Zypher Jude G Regencia
  7. Emmanuel S Baja

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Abstract

Our study identified barriers and facilitators in implementing HIV self-testing (HIVST), including the perceptions of men-having-sex-with-men (MSM) and transgender women (TGW) on HIVST. Furthermore, we explored the current knowledge, practices and potential of HIVST among the MSM and TGW populations.

Design

Qualitative in-depth key informant interviews were administered using semistructured interviews administered in both English and Filipino. Thematic analysis of the findings was done after transcribing all audio recordings.

Setting

The study was done in the National Capital Region (NCR), Philippines using online video conferencing platforms due to mobility restrictions and lockdowns caused by the COVID-19 pandemic.

Participants

All study participants were either MSM or TGW, 18–49 years old and residing/working in NCR. Exclusion criteria include biologically born female and/or currently on pre-exposure prophylaxis, antiretroviral therapy medications or an HIV-positive diagnosis.

Results

Twenty informants were interviewed, of which 75% were MSM, and most of them preferred the use of HIVST. Facilitators and barriers to the use of HIVST were grouped into three main themes: Acceptability, distribution and monitoring and tracking. Convenience and confidentiality, overcoming fears and normalisation of HIV testing services (HTS) in the country were the participants’ perceived facilitators of HIVST. In contrast, lack of privacy and maintenance of confidentiality during kit delivery were perceived as barriers in HIVST implementation. Moreover, social media was recognised as a powerful tool in promoting HIVST. The use of a welcoming tone and positive language should be taken into consideration due to the prevalent HIV stigma.

Conclusions

The identified facilitators and barriers from the study may be considered by the Philippine HTS programme implementers. The HIVST strategy may complement the current HTS. It will be very promising to involve the MSM and TGW communities and other key populations to know their HIV status by bringing testing closer to them.

Article activity feed

  1. Version published to 10.1136/bmjopen-2021-056697
  2. Version published to 10.1101/2021.09.25.21264098v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.11.13.21266310: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Informed consent forms signed online by the participants were collected from the start of the study.
    IRB: Ethical considerations: The University of the Philippines Manila Research Ethics Board (UPMREB) has approved the ethical clearance of this study with UPMREB CODE: 2019-474-01.
    Sex as a biological variableOn the other hand, individuals taking Pre-exposure Prophylaxis for HIV (PrEP), on ART, and/or female sex at birth were excluded.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were carried out using STATA 17 (www.stata.com) software.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Mobility limitations due to the COVID-19 pandemic decreased the number of HIVST kits that can be delivered primarily in cities in Metro Manila that were inaccessible due to enhanced community quarantines and lockdowns. Due to the high demand for the HIVST kits, the research team faced difficulty to follow-up participants who did not report their results. In addition, participants were not required to answer all questions if they felt uncomfortable. Thus, decreasing the data available for analysis. Since the study was conducted online, participants who did not have access to the internet were not reached. Our study, to our knowledge, is the first in the Philippines that look at the feasibility and acceptability of HIVST kits on a larger scale. Furthermore, our study findings cannot be generalizable to other high-risk and at-risk populations. Future studies are needed to explore the feasibility and acceptability of HIVST in the general population, including other key populations such as female and male sex workers, people who inject drugs, and young key populations. Additional items on demographic questionnaires and questions on condom use and sexual behaviors can be included to characterize further those who want to use the HIVST kit. Moreover, barriers and facilitators considered in accessing HIV testing and treatment must also be ascertained among participants since these could potentially help design HIVST programs effectively and efficiently in the future. Finally, in dist...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.11.13.21266310v1 on medRxiv
  5. Version published to 10.1101/2021.09.25.21264098v1 on medRxiv