Related Experiment Video
Updated: Jun 1, 2026
Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Barriers and facilitators to facility HIV self-testing in outpatient settings in Malawi: a qualitative study
Misheck Mphande1, Paula Campbell2, Risa M Hoffman2
1Partners in Hope, Box, 302, Lilongwe, Malawi. misheck@pihmalawi.com.
Insights
Facility HIV self-testing (HIVST) in outpatient departments is acceptable and convenient for patients. Key facilitators include autonomy and observed testing, while privacy concerns need addressing for wider adoption.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Services Research
Background:
- Facility HIV self-testing (HIVST) can increase HIV testing coverage in outpatient departments.
- HIVST in waiting areas offers a low-resource strategy for widespread testing.
- Barriers and facilitators to patient use of facility HIVST remain underexplored.
Purpose of the Study:
- To explore patient experiences with facility HIV self-testing (HIVST) in outpatient settings.
- To identify barriers and facilitators influencing the uptake of HIVST among outpatients.
- To inform improvements for facility-based HIV testing strategies.
Main Methods:
- Qualitative study involving in-depth interviews with 57 adult outpatients exposed to HIVST.
- Observational data collected from waiting spaces where HIVST was implemented.
- Constant comparison analysis of transcribed interview and observational data.
Main Results:
- Facility HIVST was perceived as convenient, fast, and empowering.
- Facilitators included observed testing, immediate support, and integrated HIV services.
- Barriers involved fear of judgment and lack of privacy; demand for private spaces and enhanced counseling.
Conclusions:
- Facility HIVST is largely acceptable to outpatients in Malawi.
- Novel facilitators unique to the outpatient department setting were identified.
- Addressing privacy concerns is crucial for optimizing facility-based HIVST.
Background:
Facility HIV self-testing (HIVST) within outpatient departments can increase HIV testing coverage by facilitating HIVST use in outpatient waiting spaces while clients wait for routine care. Facility HIVST allows for the majority of outpatients to test with minimal health care worker time requirements. However, barriers and facilitators to outpatients' use of facility HIVST are still unknown.
Methods:
As part of a cluster randomized trial on facility HIVST in Malawi, we conducted in-depth interviews with 57 adult outpatients (> 15 years) who were exposed to the HIVST intervention and collected observational journals that documented study staff observations from facility waiting spaces where HIVST was implemented. Translated and transcribed data were analyzed using constant comparison analysis in Atlas.ti.
Results:
Facility HIVST was convenient, fast, and provided autonomy to outpatients. The strategy also had novel facilitators for testing, such as increased motivation to test due to seeing others test, immediate support for HIVST use, and easy access to additional HIV services in the health facility. Barriers to facility HIVST included fear of judgment from others and unwanted status disclosure due to lack of privacy. Desired changes to the intervention included private, separate spaces for kit use and interpretation and increased opportunity for disclosure and post-test counseling.
Conclusions:
Facility HIVST was largely acceptable to outpatients in Malawi with novel facilitators that are unique to facility HIVST in OPD waiting spaces.
Trial Registration:
The parent trial is registered with ClinicalTrials.gov , NCT03271307 , and Pan African Clinical Trials, PACTR201711002697316.
