Exploring HIV Self-testing and Implementation Determinants among Migrants: Perspectives from sub-Saharan African Migrants and Key Informants in the Netherlands

HIV self-testing (HIVST) has the potential to increase testing uptake among populations underserved by facility/clinic-based services, including sub-Saharan African migrants (SSAM) in Europe. However, research on HIVST among SSAM in Europe and other high-income countries remains limited. This study aimed to explore perspectives on HIVST, identify barriers and facilitators to HIVST uptake, and provide recommendations to inform effective implementation among a diverse group of 26 SSAM and 13 key informants in the Netherlands through semi-structured interviews. Interview data were analyzed using inductive thematic analysis. Participants’ perspectives on HIVST centered on three themes: enhanced autonomy in decision-making and testing processes; navigating autonomy and support for self-testing and care linkage; and HIVST within the Dutch context and prevention landscape. The Consolidated Framework for Implementation Research (CFIR) was subsequently employed as a post-hoc interpretive framework to map study findings within a broader implementation context. Factors potentially influencing successful uptake and implementation were identified across multiple CFIR domains, including perceived relative advantage over facility/clinic-based testing, evidence on reliability, and procedural complexity (Innovation Characteristics); low self-efficacy, self-testing and linkage to care support needs (Individual Characteristics); HIV stigma, limited awareness and low visibility of HIVST (Outer Setting); and perceived incompatibility with existing healthcare systems (Inner Setting). Although HIVST can address key testing barriers among SSAM, targeted implementation strategies are needed to guarantee equitable access, proper use, and optimal outcomes. These include enhanced dissemination of HIVST information, normalization of HIV testing and self-testing, provision of person-centered support, and establishing clear pathways for timely care linkage when required.