Abstract
BACKGROUND: HIV self-testing (HIVST) is a way to improve HIV status knowledge and access to HIV testing. Since 2019, the ATLAS project has introduced, promoted, and delivered HIVST in Côte d'Ivoire, Mali, and Senegal, in particular among female sex workers (FSW), men who have sex with men (MSM), people who use drugs (PWUD), these key populations being particularly vulnerable to HIV and stigmatized in West Africa. Stakeholders involved in HIV testing activities targeting key populations are essential for the deployment of HIVST. Here, we analyze their perceptions of the introduction of HIVST in their countries.METHODS: A qualitative survey was conducted from September to November 2019 within three months of HIVST distribution initiation. Individual interviews were conducted with 60 stakeholders (Côte d'Ivoire, 19; Mali, 20; Senegal, 21). Semi-structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose"© software for thematic analyses.RESULTS: In the three countries, stakeholders express enthusiasm and willingness to introduce HIVST for several reasons. HIVST is considered able to reduce stigma, preserve anonymity and confidentiality, especially for MSM and PWUD; reach key populations that do not access testing via usual strategies and HIV+ key populations; remove spatial barriers; save time for providers and users, notably for FSW; and empower users with autonomy and responsibility. HIVST is noninvasive and easy to use. Secondary distribution of HIVST seems appropriate for reaching partners of MSM, with confidentiality. However, stakeholders expressed doubts about key populations' ability, particularly PWUD, to correctly use HIVST kits, ensure quality secondary distribution, accept a reactive test result, and use confirmation testing and care services. They also mentioned that FSW might have difficulties redistributing HIVST to their clients and partners.CONCLUSIONS: HIVST is considered an attractive strategy to improve access to HIV testing for key populations. The doubts about users' capacities could be a matter of reflective communication with stakeholders before HIVST implementation in other western African countries.