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Understanding and Preventing Potential Social Harms and Abuses of Oral HIV Self-Testing in Kenya

KENYA, 2013
Health and Well-Being (HaW)
African Population and Health Research Center
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Identification

IDNO
APHRC-OralHIVSelf-Testing-2013-1.1
Title
Understanding and Preventing Potential Social Harms and Abuses of Oral HIV Self-Testing in Kenya
Translated Title
ENGLISH
Country
Name Country code
KENYA KEN
Abstract
HIV/AIDS remains a leading cause of morbidity and mortality in sub-Saharan Africa. HIV disproportionately affects women and youth aged 15-24 years. The majority of those living with HIV/AIDS (69%) as well as the largest proportion of new infections (72%) are in sub-Saharan Africa. The percentage of the general population who are aware of their HIV status is less than 20%, a factor that may explain the large numbers in new infections each year relative to other regions of the world. In response to preliminary findings indicating relatively high approval and potential acceptance of oral HIV self-testing, this study aimed to assess and quantify perceived social harms and abuses that may arise from widespread availability of oral HIV testing kits and to describe possible actions to prevent these harms and abuses. Using both qualitative and quantitative approaches, the study explored potential social harms and abuses that could emanate from self-testing and assessed potential strategies to mitigate these harms and abuses. Information on approaches to mitigate these harms and abuses was also collected. The results of this study are expected to inform the design, development and implementation of HIV prevention and control strategies aimed at promoting the safe use of oral HIV self-testing kits as an alternative to conventional avenues of HIV testing.

Version

Version Notes
Version 1.1, November 2014. Anonymized with DOI and Recommended Citation added.

Scope

Keywords
Keyword
HIV
Testing
Self-testing
Abuses
Harms
Counseling

Coverage

Geographic Coverage
The study was conducted in three sites:

1. Nairobi informal settlements (Viwandani and Korogocho)

2. Nairobi formal housing (Jericho and Harambee)

3. Rural Machakos (Kinanie, Muthwani and Mathatani )
Unit of Analysis
Individuals
Universe
Males and females adults aged 15-49 years

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
African Population and Health Research Center APHRC
Producers
Name Affiliation Role
Caroline W Kabiru, PhD African Population and Health Research Center (APHRC) Principal Investigator
Chimaraoke Izugbara, PhD African Population and Health Research Center (APHRC) Co-Principal Investigator
Estelle M Sidze, PhD African Population and Health Research Center (APHRC) Co-Investigator
Damar Osok African Population and Health Research Center (APHRC) Program Assistant
Thaddaeus Egondi African Population and Health Research Center (APHRC) Data Analyst
Clement Oduor African Population and Health Research Center (APHRC) Field Cordinator
Funding Agency/Sponsor
Name Abbreviation Role
International Initiative for Impact Evaluation, Inc 3ie Funder
Other Identifications/Acknowledgments
Name Role
International Initiative for Impact Evaluation, Inc. Funding
Bill and Melinda Gates Foundation Partial Funding for analysis time
Sida Partial Funding for analysis time
William and Flora Hewlett Foundation Partial Funding for analysis time
Rockefeller Foundation Partial Funding for analysis time

Sampling

Sampling Procedure
For the quantitative study, participants were randomly-selected from the study communities to ensure sufficient numbers of urban and rural residents, as well as males and females of different ages. In each community, enumeration areas were randomly selected and every household within selected EAs was visited. Fieldworkers recruited alternately one young female (15-24 years), an older female (25-49 years), young male (15-24 years), or an older male (25-49 years) from the household until the desired sample size of 970 was achieved.



Regarding the qualitative study, 12 focus group discussions (FGDs) were conducted with 4 FGDs in each of the three study sites. Each FGD comprised between 6-10 persons and was age and gender-specific

Participants for individual interviews (IDIs) and key informants were purposively-selected.
Response Rate
A total of 1139 individuals were interviewed (Viwandani-189, Korogocho-170, Jericho-223, Harambee- 206 and Machakos-351).



A total of 13 age and gender-specific focus group discussions (FGDs) of between 6-10 persons (n=118), 26 in-depth individual interviews (IDIs) and 5 key informants were conducted in the study sites.
Weighting
Data not weighted

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date
2013-08-15 2013-09-28
Time periods (YYYY/MM/DD)
Start date End date
2013-08-25 2013-09-28
Mode of data collection
Face-to-face [f2f]; Focus-group discussion; Indepth-interview
Supervision
Field workers were divided in four teams of 5 persons, with each team being headed by a supervisor. Every field worker had a manual that served as a guide for field interviews. The research officer assigned areas to supervisors who in turn assigned specific households to each enumerator for actual interview. Supervisors assigned duties to their team members on a daily basis and ensure the work is properly done. Overall, a field coordinator was in charge of the field work operations. The coordinator supervised the field supervisors and ensured that work was of excellent quality and done in an efficient manner. The field coordinator was also responsible for field logistics to and from the field.



Completed quantitative interviews were sent electronically to the supervisor each day for quality checks and also synchronized to the main database on a daily basis. Preliminary cleaning was performed to identify implausible values for verification in the field before analytical data sets were prepared for use and storage.
Type of Research Instrument
The individual questionnaire was administered in Kiswahili to each eligible respondent in the selected households. The questionnaire included sections on household characteristics, socio-demographics, HIV knowledge, HIV stigma and perceived risk and oral HIV self-testing. Quantitative data were collected electronically using netbooks.

The qualitative tools (FGD, IDI and Key informant interview) included sections on HIV -related knowledge, HIV testing and HIV self-testing.

Data Processing

Cleaning Operations
Data labeling and final verification checks were conducted by project data analyst for quantitative data which were analyzed using Stata 12.



Qualitative records were transcribed into English. Analysis of the qualitative data entailed a manual synthesis of transcripts using thematic, content and narrative analyses to provide a robust picture of the potential harms and abuses that could result from HIV self-testing. It also entailed summarizing information on suggested ways of introducing HIV self-testing to minimize the perceived social harms and abuses. The analysis was done collectively by the study team.
Other Processing
Data were collected electronically using netbooks during the interviews for quantitative survey while for qualitative survey the interviews were audio-recorded and transcribe.

Data access

Contact
Name Affiliation Email URI
African Population and Health Research Center APHRC info@aphrc.org www.aphrc.org
Conditions
All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research. This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained (as outlined on this form) and to abide by the conditions outlined below:

1. Data Ownership: The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.

2. Purpose: The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.

3. Respondent Identifiers: The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.

4. Confidentiality pledge: The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.

5. Reporting of errors or inconsistencies: The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.

6. Publications resulting from APHRC data: The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.

7. Security: The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.

8. Loss of privilege to use data: In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.

9. Acknowledgement: Any work/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:

“This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City.”

Additionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.

10. Deposit of Reports/Papers: The user should submit electronic and paper copies of all publications generated using APHRC data to the Policy Engagement and Communications Department, with copies to the Director of Research.

11. Change of contact details: The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.
Citation requirement
African Population and Health Research Center, Understanding and Preventing Potential Social Harms and Abuses of Oral HIV Self-Testing in Kenya, December 2013. APHRC, Nairobi - Kenya. doi:11239/176-2013-001-1.1

Contacts

Contact
Name Affiliation Email
Head, Statistics and Survey Unit African Population and Health Research Center datarequests@aphrc.org

Metadata production

Document ID
APHRC-OralHIVSelf-Testing-2013-1.1
Producers
Name Abbreviation Affiliation Role
African Population and Health Research Center APHRC APHRC Metadata Producer
Date of Production
2013-12-16
Document version
Version 1.1