Empowering Vulnerable Communities Through HIV Self-Testing: Post-COVID-19 Strategies for Health Promotion in Sub-Saharan Africa

Abstract

HIV remains a significant public health challenge in sub-Saharan Africa (SSA), with vulnerable communities disproportionately affected and further marginalised by the COVID-19 pandemic. HIV self-testing (HIVST) has emerged as a transformative, empowering tool to bridge testing gaps and promote health equity. This study examined post-COVID-19 strategies for leveraging HIVST to empower vulnerable populations and advance health promotion in SSA. Analysis was performed using secondary Demographic and Health Survey (DHS) data (2015-2022) collected across 24 SSA countries. In addition, qualitative interviews were conducted with female sex workers in Port Harcourt, Nigeria (18-31 May 2023). The study adopted an explanatory sequential mixed-methods design. Quantitative analysis using complex sample logistic regression revealed low awareness (16.3%) and uptake (2.5%) of HIVST among the 594,639 respondents. Key predictors of uptake included higher education (aOR, 7.36; 95% CI, 6.62-8.18), wealth (richest quintile aOR, 3.28; 95% CI, 2.95-3.65), and knowledge of HIV transmission (aOR, 33.43; 95% CI, 11.03-101.24). Thematic analysis highlighted privacy, autonomy, and convenience as key benefits, while cost, stigma, and fear of testing alone were major barriers. The participants emphasised peer-led outreach and integration of HIVST into public health systems as effective strategies. The findings were integrated interpretively, linking macro-level testing disparities with community-level experiences to inform post-pandemic policy and programme design. The study concludes that HIVST holds strong potential to empower marginalised groups and strengthen community-driven HIV prevention post-COVID-19, but success will depend on equity-driven policies and sustainable implementation frameworks, guided by affordability and community participation.