title: What should the ideal HIV self-test look like? A usability study of test prototypes in unsupervised HIV self-testing in Kenya, Malawi, and South Africa.
abstract: HIV self-testing (HIVST) is increasingly being sought and offered globally, yet there is limited information about the test features that will be required for an HIV self-test to be easy to use, acceptable to users, and feasible for manufacturers to produce. We conducted formative usability research with participants who were naïve to HIVST using five prototypes in Kenya, Malawi, and South Africa. The tests selected ranged from early-stage prototypes to commercially ready products and had a diverse set of features. A total of 150 lay users were video-recorded conducting unsupervised self-testing and interviewed to understand their opinions of the test. Participants did not receive a test result, but interpreted standardized result panels. This study demonstrated that users will refer to the instructions included with the test, but these can be confusing or difficult to follow. Errors were common, with less than 25% of participants conducting all steps correctly and 47.3% of participants performing multiple errors, particularly in sample collection and transfer. Participants also had difficulty interpreting results. To overcome these issues, the ideal HIV self-test requires pictorial instructions that are easy to understand, simple sample collection with integrated test components, fewer steps, and results that are easy to interpret.
authors.affiliation: PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA, rpeck@path.org.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Peck
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Lim
authors.forename: Heidi
authors.initials: H
authors.lastname: van Rooyen
authors.forename: Wanjiru
authors.initials: W
authors.lastname: Mukoma
authors.forename: Lignet
authors.initials: L
authors.lastname: Chepuka
authors.forename: Pooja
authors.initials: P
authors.lastname: Bansil
authors.forename: Lucia C
authors.initials: LC
authors.lastname: Knight
authors.forename: Nelly
authors.initials: N
authors.lastname: Muturi
authors.forename: Ellen
authors.initials: E
authors.lastname: Chirwa
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Lee
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Wellhausen
authors.forename: Olivia
authors.initials: O
authors.lastname: Tulloch
authors.forename: Miriam
authors.initials: M
authors.lastname: Taegtmeyer
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods* / Q000706:statistics & numerical data; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007630:Kenya; D008295:Malawi; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D011933:Reagent Kits, Diagnostic; D012648:Self Care; D012680:Sensitivity and Specificity; D013019:South Africa
chemical_list: D011933:Reagent Kits, Diagnostic