"How will I know the results if I self-test at home?" – At-home HIV self-testing vs. at-clinic HIV testing preference among trans-women in Ghana's Slums. BSGH-015

Abstract

Despite a higher HIV prevalence (28%) among trans-women compared to other groups, no studies have examined HIV testing preferences among trans-women in Ghana. However, they continue to face individual and structural barriers to HIV testing in the country. This study therefore marks the first investigation into the HIV testing or self-testing preferences of trans-women in the country. A community organization used snowballing to recruit trans-women (n=20) to participate in face-to-face interviews about their experiences with testing and perspectives about HIV self-testing in comparison to traditional testing in clinics. Using NVIVO, we coded and conducted a thematic analysis to understand the participants' perspectives. Three categories of preferences emerged: 1) Some shared a preference for HIV self-testing at home because it offers privacy and confidentiality, saves time and transportation costs, and swerves stigmatizing attitudes of health workers. 2) Some prefer testing at a clinic as it offers the availability of professional care; they cannot conduct self-testing and interpret the results successfully, but they can access counseling therapy and other STI testing at healthcare facilities. 3) Others had mixed location preferences, expressing that they could benefit from both and use either option based on availability. The preferences expressed by participants suggest a need for holistic services where trans-women can test using self-testing kits and also have access to additional STI tests or counseling and linkage to care. It also points to the need to focus on fundamental issues such as ensuring privacy and confidentiality and better experiences in healthcare facilities as they remain drivers and deterrents for both testing approaches and potential linkage to care.