title: Acceptability of a Community-Based Outreach HIV-Testing Intervention Using Oral Fluid Collection Devices and Web-Based HIV Test Result Collection Among Sub-Saharan African Migrants: A Mixed-Method Study.
abstract: BACKGROUND
  Late human immunodeficiency virus (HIV) diagnosis is common among sub-Saharan African migrants. To address their barriers to HIV testing uptake and improve timely HIV diagnoses and linkage to care, the outreach HIV testing intervention, "swab2know," was developed. It combined a community-based approach with innovative testing methods: oral fluid self-sampling and the choice between Web-based HIV test result collections using a secured website or post-test counseling at a sexual health clinic. The sessions included an informational speech delivered by a physician of sub-Saharan African origin and testimonies by community members living with HIV.
  
  
  OBJECTIVE
  The objectives of this study were to evaluate the intervention's acceptability among sub-Saharan African migrants and its potential to reach subgroups at higher risk for HIV infection and to identify facilitators and barriers for HIV testing uptake.
  
  
  METHODS
  This mixed-method study combined qualitative (participant observations and informal interviews with testers and nontesters) and quantitative data (paper-pencil survey, laboratory data, and result collection files). Data were analyzed using a content analytical approach for qualitative and univariate analysis for quantitative data.
  
  
  RESULTS
  A total of 10 testing sessions were organized in sub-Saharan African migrant community venues in the city of Antwerp, Belgium, between December 2012 and June 2013. Overall, 18.2% of all people present (N=780) underwent HIV testing; 29.8% of them tested for HIV for the first time, 22.3% did not have a general practitioner, and 21.5% reported 2 or more sexual partners (last 3 months). Overall, 56.3% of participants chose to collect their HIV test results via the protected website. In total, 78.9% collected their results. The qualitative analysis of 137 participant observation field notes showed that personal needs and Internet literacy determined the choice of result collection method. Generally, the oral fluid collection devices were well accepted mainly because sub-Saharan African migrants dislike blood taking. For some participants, the method raised concerns about HIV transmission via saliva. The combination of information sessions, testimonies, and oral fluid collection devices was perceived as effectively reducing thresholds to participation. Acceptability of the intervention differed between individual participants and settings. Acceptance was higher among women, in churches and settings where community leaders were engaged in HIV awareness raising. Higher preventive outcomes were observed in settings with lower acceptance. The presence of the intervention team visualized the magnitude of the HIV epidemic to the public and promoted HIV testing uptake at large, for example, those who declined indicated they would take up testing later.
  
  
  CONCLUSIONS
  When accompanied by tailored provision of information, outreach HIV testing interventions adopting a community-based approach and innovative methods such as Web-based result collection and oral fluid collection devices are acceptable and reduce thresholds for HIV testing uptake. The swab2know intervention was able to reach sub-Saharan African migrants at risk of HIV infection, and with limited access to regular HIV testing. Among nontesters, the intervention contributed to awareness raising and therefore has a place in a multipronged HIV test promotion strategy.
authors: HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. jloos@itg.be.
authors: Jasna
authors: http://orcid.org/0000-0002-3081-5409
authors: J
authors: Loos
authors: Lazare
authors: http://orcid.org/0000-0002-4162-4210
authors: L
authors: Manirankunda
authors: Tom
authors: http://orcid.org/0000-0002-5906-4530
authors: T
authors: Platteau
authors: Laura
authors: http://orcid.org/0000-0001-7107-4400
authors: L
authors: Albers
authors: Katrien
authors: http://orcid.org/0000-0003-2127-4599
authors: K
authors: Fransen
authors: Tine
authors: http://orcid.org/0000-0002-8895-1112
authors: T
authors: Vermoesen
authors: Fiona
authors: http://orcid.org/0000-0002-6983-2185
authors: F
authors: Namanya
authors: Christiana
authors: http://orcid.org/0000-0001-9031-8503
authors: C
authors: Nöstlinger
keywords: Web-based HIV test result; acceptability; oral fluid collection devices; outreach HIV testing; sub-Saharan African migrants