Awareness, acceptability and factors associated with willingness to indicate HIV self-testing among health care providers from HIV specialized care services in Northeast of Brazil

BACKGROUND: The largest gap in Brazil is for the initial 90-90-90 UNAIDS goals, 90% of people living with HIV know their HIV status. The inclusion of the HIV self-testing (HIVST) at the Brazilian National Health System (SUS) has been a recent effort to increase HIV early diagnoses. The engagement of health care providers (HCP) to promote HIVST in HIV/AIDS clinics is essential to make HIVST even more accessible to most at risk populations. We aimed to investigate the awareness, acceptability and factors associated with the willingness to indicate the HIVST among HCP in Northeast Brazil.
METHODS: A cross sectional study with HCP in 29 HIV/AIDS specialized care services from 21 cities from Bahia state, Northeast of Brazil. The services were selected using a conglomerate sampling scheme in one phase, and the HCP by convenience sampling. Sociodemographic, occupation and behavior data were collected using a structured questionnaire between October 2019 and March 2020. Adjusted logistic regression models are used to estimate odds ratio (aOR) and 95% confidence intervals (95%CI).
RESULTS: Most of the 252 HCP were women (78.2%), between 35 and 50 years old (54.4%), with college degree education (84.5%), nurses with college degree (25.8%) and high school degree (11.9%), pharmacists (12.3%) and physicians (11.9%). The HIVST awareness, acceptability and willingness to indicate it were: 79.8% (95%CI: 74,3-84,3), 55.2% (95%CI: 48,9-61,2) and 47.1% (95%CI: 40,9-53,4), respectively. Only 13.5% of HCP received some training on ATHIV and 23% reported having knowledge of its offer in SUS. The main reasons to no indication were: concerns about suicidal risk (75.4%), wrong reading of results (68.4%) and self-aggression due to a positive result (61.5%). Factors associated with the willingness to indicate an HIVST were: HIVST acceptability (aOR= 9.5; 95%CI: 4.5-19.7), agreement to use it on yourself (aOR= 4.5; 95%CI: 1.6-12.2), diagnostic confidence (aOR= 5.7; 95%CI: 2.3-12.7) and consider the general public eligible for HIVST (aOR= 2.9; 95%CI: 1.2-6.6).
CONCLUSIONS: Although the HIVST awareness among HCP was high, acceptability and willingness to indicate it was moderate. It is needed to increase HIVST training among HCP in Brazil, and demystify concerns related to this technology.