Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: A qualitative study

Background: Increasing routine HIV testing among key populations is a public health imperative, so improving access to acceptable testing options for those in need is a priority. Despite increasing targeted distribution and uptake of HIV self-sampling kits (SSKs) among men who have sex with men in the UK, little is known about why targeted SSK interventions for black African users are not as wide-spread or well-used. This paper addresses this key gap, offering insight into why some groups may be less likely than others to adopt certain types of SSK interventions in particular contexts. These data were collected during the development phase of a larger study to explore the feasibility and acceptability of targeted distribution of SSKs to black African people. Methods: We undertook 6 focus groups with members of the public who self-identified as black African (n=48), 6 groups with specialists providing HIV and social services to black African people (n=53), and interviews with HIV specialist consultants and policy-makers (n=9). Framework analysis was undertaken, using inductive and deductive analysis to develop and check themes. Results: We found three valuable components of targeted SSK interventions for this population: the use of settings and technologies that increase choice and autonomy; targeted offers of HIV testing that preserve privacy and do not exacerbate HIV stigma; and ensuring that the specific kit being used (in this case, the TINY vial) is perceived as simple and reliable. Conclusions: This unique and rigorous research offers insights into participants’ views on SSK interventions, offering key considerations when targeting this population. . Given the plethora of HIV testing options, our work demonstrates that those commissioning and delivering SSK interventions will need to clarify (for users and providers) how each kit type and intervention design adds value. Most significantly, these findings demonstrate that without a strong locus of control over their own circumstances and personal information, black African people are less likely to feel that they can pursue an HIV test that is safe and secure. Thus, where profound social inequalities persist, so will inequalities in HIV testing uptake – by any means. Background In the UK heterosexuals of black African ethnicity are estimated to be between 20 and 40 times more likely to have HIV infection than the rest of the national population. Similarly, with disproportionate diagnoses reported among non-UK born homosexually active men, we would expect black African men who have sex with men (MSM) to be more at risk of HIV than their non-African counterparts [1]. In addition, black African people are overrepresented among those who present to UK HIV services with advanced disease accompanied by the myriad public health and personal wellbeing implications associated with delayed presentation [1]. Although a considerable proportion of HIV testing in the UK is undertaken through sexual health clinics, these settings tend not to be regularly attended by black African people [2] [3] and HIV screening in antenatal services is only accessed by pregnant women. Primary care services are utilised by black African people, however opportunities for earlier HIV diagnosis in such settings are often missed [4]. Historically there have proven to be many social issues that prevent timely HIV testing among black African