Detecting HIV positive cases among first-time testers using HIV self-testing strategy: evidence from a large-scale cross-sectional study in Cameroon

Abstract

ABSTRACT Introduction To end AIDS by 2030, barriers in accessing routine HIV testing services must be addressed, especially in high-risk populations. Innovative strategies such as HIV self-testing (HIVST) represent an opportunity to overcome the existing gaps. We aimed at characterizing HIV first-time testers (HFTs) and evaluating the effectiveness of HIVST among HFTs. Methods A cross-sectional study was conducted in three regions of Cameroon. Oral HIVST kits were distributed using four distribution models: community model (CM), workplace model (WM), partners of PLHIV model (pPLHIVM), and other health facility entry points model (oHFM). Results Overall, 6018 HFTs were analysed; 69.8% were males (male/female ratio: 2.3) and 82.2% were <30 years (<20 years: 26.4%, 20-29 years: 55.7%). Most kits were distributed using primary distribution type (78.1%) and CM (69.7%). Concerning HIVST outcomes, 2.3% (n=137) and 0.7% (n=39) had reactive and invalid test results, respectively. Of them, 45.5% did not show up for confirmation; most of them had <20 years (78.0%) and received their kits through primary distribution (73.6%). However, a concordance of 77.1% was found between the results of HIVST and health-care workers (HCW); the lowest rate was observed in <20 years (55.6%). The overall HIV seropositivity rate was 1.2%. Compared to individuals aged 40-49 years (4.6%), those <20 years and 20-29 years had a seroprevalence <1%, p<0.001. pPLHIVM showed the highest prevalence (18.2%), compared to CM (0.1%), p<0.001. Using the conditional backward stepwise regression model, predictors of seropositivity were region, distribution type, and distribution models. Compared to primary distribution, secondary distribution had 51 times odd of positive test (aOR [95% CI]: 51.447 [4.627-572.010]). Conclusions About 70% of HFTs were males and 80% had <30 years. Only 54% showed up for confirmation testing, but a good concordance (77%) of test results between HFTs and HCWs was observed. HIV seropositivity was low, with a much higher rate among partners of PLHIV. This real-life data suggests that HIVST could play an important role in achieving the first 95% UNAIDS targets, especially among males and young people.