Perceived Acceptability of a Facility-Based HIV Self-Test Intervention in Outpatient Waiting Spaces Among Adult Outpatients in Malawi: A Formative Study.

Background:: Facility-based HIVST offered to outpatients in clinic waiting spaces provides an ideal opportunity to take HIVST to scale in low-resource settings. We explore if outpatients are willing to use HIVST kits in outpatient waiting spaces before they receive routine services in Malawi.

Methods:: A formative qualitative study was conducted to inform the design of a multi-arm clustered randomized trial. In-depth interviews were conducted with 36 adults (≥ 15 years) seeking outpatient services at five high-burden health facilities in Central and Southern Malawi. Outpatients were purposively sampled on the day of clinic visit. Before the interview, research staff described a hypothetical facility-based HIVST intervention. Data were analyzed using constant comparison analyses.

Findings:: The vast majority of respondents believed facility-based HIVST in outpatient waiting spaces was acceptable and desired, especially among men. Participants believed the strategy may decrease potential stigma associated with testing due to an opt-out approach, and may increase clients’ willingness to test again in the near future because it will help overcome fears related to an unknown HIV test result. The strategy was also seen as confidential and convenient. A minority of clients believed private spaces for conducting HIVST in facilities were needed.

Conclusion:: Facility-based HIVST in outpatient waiting spaces is acceptable and desired among adult outpatients in Malawi. Notably, few respondents were concerned about lack of privacy.