“When you provide an HIV self-testing kit […] you also need to know the results”: lay providers’ concerns on HIV self-testing provision to peers, ATLAS project

Background: HIV self-testing (HIVST) is a process in which a person collects his or her own specimen (oral fluid or blood), using a simple rapid HIV test and then performs the test and interprets the result, often in a private setting, either alone or with someone he/she trusts (WHO, 2018). HIVST is convenient to reach stigmatized groups such as key populations. In the ATLAS project, provision of HIVST kits is done by lay providers to sex workers, drug users and men who have sex with men, or through secondary distribution by primary contacts to their partners and other peers. There is a shifting of paradigm because the result of an HIVST is not necessarily shared with the lay provider. How do lay providers responsible for HIVST kits distribution to key populations in West Africa adopt this new testing strategy? This abstract discusses the concerns of lay providers who offer HIVST kits to peers in the ATLAS Project (Cote d’Ivoire, Mali and Senegal).Material and Methods: We conducted seven focus group discussions with fifty-six lay providers who had experience in offering HIVST to peers (sex workers, men who have sex with men, drug users) in the three countries two months after the ATLAS project started.Results: Lay providers report no major opposition or conflict in offering HIVST kits. Testimonies from primary recipients also suggest that the HIVST was performed correctly in the case of secondary distribution. However, lay providers’ concerns remain with the lack of knowledge of the self-test results. In previous HIV testing strategies, providers usually played a key role to support their client during pre- and post-test counselling, especially when the test result was positive. Therefore, their question is how can they continue to support peers while respecting the private nature of self-testing? The concern is at two levels. At the individual level, lay providers fear that the continuum of care is not guaranteed and peers who self-test with a reactive test result may stay alone. At the collective level, lay ...