Stakeholder experiences of an intervention for provision of HIV self-testing kits and contraception to adolescent girl and young women in privately-owned drug shops in sub-Saharan Africa


BACKGROUND: Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face dual burdens of 25% of new adult HIV infections and 44% of unintended births. Accredited drug dispensing outlets (ADDO) are found throughout local communities and may be a resource to provide sexual reproductive health (SRH) products to AGYW.
METHODS: The Malkia Klabu ('Queen Club') intervention is a loyalty program facilitating access to HIV self-testing (HIVST) and contraception developed with stakeholders through a human centered design process to overcome stigma associated with AGYW accessing SRH resources. AGYW present a loyalty card to secure prizes, receive free HIVST, pregnancy tests, and use a symbol card to request SRH products without having to request them verbally. ADDOs in the control arm received HIVST kits to distribute to AGYW for free. Following a 4-month randomized cluster trial of 20 ADDOs in Shinyanga, Tanzania, AGYW (n=11), shopkeepers (n=26), and counselors (n=3) participated in in-depth interviews. Using modified grounded theory, translated transcripts were reviewed by a team of four data analysts not otherwise associated with the program to identify key ideas and develop a codebook. The analysis team reviewed coding clusters to identify emergent themes.
RESULTS: AGYW reported a relative advantage to safely and easily access HIVST. The HIVST was popular among AGYW, because it offered privacy to test in one's own home. AGYW who had previous experience of testing in health centers (blood test) preferred the HIVST because it is less painful, yields fast results, and affords greater privacy. The primary motivation of AGYW to test was to 'know one's status.' Confirming that they were HIV negative was a relief, but AGYW also expressed that finding out that one was HIV positive enabled them to take control of their health.
CONCLUSIONS: AGYW valued knowing their status and equated it with control and power. Stigma associated with sexual activity of AGYW continues to surround the act of testing for HIV, but provision of HIVST by ADDOs is one way to promote knowing one's status without incurring stigma. Privately owned ADDOs are an adequate way to deliver AGYW-friendly HIVST and other SRH products.