“Bringing testing closer to you” – Barriers and Facilitators in Implementing HIV Self-Testing among Filipino Men-Having-Sex-with-Men and Transgender Women in National Capital Region (NCR), Philippines: A Qualitative Study

Abstract

ABSTRACTObjectivesOur study identified barriers and facilitators in implementing HIV Self-Testing (HIVST), including the perceptions of men-having-sex-with-men (MSM) and transgender women on HIVST. Furthermore, we explored the current knowledge, practices, and potential of HIVST among the MSM and TGW populations.DesignQualitative in-depth Key Informant Interviews (KIIs) were conducted using semi-structured interviews administered in both English and Filipino. Thematic analysis of the findings was done after transcribing all audio recordings.SettingThe study was done in the National Capital Region (NCR), Philippines using online video conferencing platforms due to mobility restrictions and lockdowns caused by the COVID-19 pandemic.ParticipantsAll study participants were either MSM or TGW, 18 to 49 years old, and residing/working in NCR. Exclusion criteria include biologically born female and/or currently on pre-exposure prophylaxis (PrEP), antiretroviral therapy (ART) medications, or an HIV-positive diagnosis.ResultsTwenty informants were interviewed, of which 75% were MSM, and most of them preferred the use of HIVST. Facilitators and barriers to the use of HIVST were grouped into three main themes: Acceptability, distribution, and monitoring and tracking. Convenience and confidentiality, overcoming fears, and normalization of HIV testing services (HTS) in the country were why the participants preferred HIVST. In contrast, lack of privacy and maintenance of confidentiality during kit delivery were perceived as barriers in HIVST implementation. Moreover, social media was recognized as a powerful tool in promoting HIVST. The use of a welcoming tone and positive language should be taken into consideration due to the prevalent HIV stigma.ConclusionsThe identified facilitators and barriers from the study may be considered by the Philippine HTS program implementers. The HIVST strategy may complement the current HTS. It will be very promising to involve the MSM and TGW communities and other key populations to know their HIV status by bringing testing closer to them.STRENGTH AND LIMITATIONSGathering participants and building trust to give their insights did not pose any difficulty because the community-based organization is reputable among the key populations (MSM and TGW) and HIV advocacy in the Philippines.Our study only involved respondents from the National Capital Region, which may limit its generalizability to other regions of the country where HIV cases are still increasing.Key informant interviews were done online due to the COVID-19 pandemic; thus, some reactions to the questions of the participants are not noted due to the unavailability of video and weak internet connectivity.The perceived acceptability of HIVST from the informants is suggestive, and the majority of the participants had not used the HIVST before.Our study only involved the MSM and TGW populations and did not include other at-risk and high-risk populations, limiting its applicability to different populations.