Adolescent and young adult participation in HIV self-testing: secondary analysis of cross-sectional data from Nigeria

Abstract

BACKGROUND: Youth participation is critical to improving HIV prevention outcomes, yet evidence on the quality of adolescent and young adult (AYA) participation in HIV self-testing programs in low- and middle-income countries remains limited. This study assessed levels and correlates of AYA participation in HIV self-testing interventions implemented in Nigeria. METHODS: We conducted a secondary analysis of data from the Innovative Tools to Expand Youth-friendly HIV Self-Testing study, which recruited AYA aged 14-24 years from four Nigerian sites (September 2019-March 2020). Participation was measured using an adapted 12-item Tiffany-Eckenrode Program Participation Scale across four domains: ownership, voice/influence, support and community participation. Scores ranged from 0 (strongly disagree) to 4 (strongly agree) and were categorized as minimal (<3.5), moderate (3.5-4.0) or substantial (>4.0). Chi-squared tests examined associations between participation levels and sociodemographic variables, with Cramér's V summarizing effect sizes. RESULTS: Among 388 AYA (mean age 21 ± 2 years; 58% male), overall participation was high (M = 4.04 ± 0.24). Domain-specific analyses showed substantial participation in support (M = 4.08 ± 0.23), community participation (M = 4.04 ± 0.24) and ownership (M = 3.94 ± 0.27), whereas voice/influence was moderate (M = 3.87 ± 0.32). Education (χ2 = 43.23, P < 0.001; V = 0.33), employment (χ2 = 122.70, P < 0.001; V = 0.56) and income (χ2 = 119.68, P < 0.001; V = 0.55) were significantly associated with participation, whereas age, sex and marital status were not. CONCLUSION: These findings highlight generally high AYA participation in HIV self-testing interventions, but underscore socioeconomic disparities that may shape participation quality. Programs should prioritize equitable engagement strategies for youth with fewer resources.