The Population Council and University of Lagos propose to conduct a feasibility and acceptability study of HIV self-testing (HST) among men who have sex with men (MSM) in Lagos, Nigeria. MSM in Nigeria bear a disproportionately high burden of HIV (17%) and face high levels of stigma, discrimination, and criminalization. In such a hostile and homophobic environment where human rights abuses are rife, MSM have poor access to HIV prevention, care and treatment services, including HIV testing and counselling (HTC). In addition, 55% of Nigerian MSM and 62% of MSM in Lagos have never tested for HIV, suggesting that many HIV-positive MSM are not linked to care and treatment. The goal of this study is to address a critical barrier to MSM accessing HIV testing and treatment by testing the acceptability, feasibility, and a potential peer-driven distribution model of HST among MSM in Nigeria.
The aims of this proposal are: 1) To investigate the acceptability, feasibility, and operational aspects of an HST distribution through the use of key opinion leaders (KOLs; or MSM peer educators) in Lagos, Nigeria; and 2) To examine real-world distribution feasibility, product uptake and utilization, and linkages to post-test counselling and treatment by implementing a distribution model wherein KOLs are deployed to distribute HST kits to MSM in their social networks. Outcomes of interest are uptake of HST, use of HST by sex partners, and linkage to post-test counselling and treatment. To meet Aim 1, in-depth interviews (IDI) with MSM and focus group discussions (FGD) with KOLs will be conducted to understand how MSM perceive HST, assess willingness to use and potential barriers to uptake of HST, and identify operational and contextual issues that might affect the demonstration, distribution, and utilization of HST kits among MSM. Observations of a small sample of MSM conducting HIV self-testing on will also be conducted to assess accurate use of the product, and revise product instructions accordingly. To meet Aim 2, a quantitative survey with a cohort of HIV negative or unknown status MSM (N=300) who are reached by KOLs will be conducted. Follow-up interviews will be conducted after three months to allow for sufficient time for those who test positive to seek care and treatment. IDIs with a subsample of the cohort will be conducted post-intervention to assess acceptability, ease of and barriers to use, unintended consequences, reasons for use or non-use, and facilitators of and barriers to linkages to care and treatment. FGDs with KOLs will also be conducted at endline to assess operational aspects and challenges to HST kit distribution. The proposed study builds on Population Council's existing PEPFAR-funded (Department of Defense) service delivery program that has successfully been using KOLs to deliver important HIV services to MSM in Lagos. The study will provide critical information on how self-testing can be offered to a high-risk group with low rates of HIV testing. It will also bridge evidence gaps and facilitate policy changes to include HST into national HIV testing guidelines.
HIV self-testing has enormous potential of reaching and increasing HIV testing and linking Nigerian men who have sex with men (MSM), a population that faces high levels of homophobia, criminalization and high HIV burden and unmet need for HIV testing to early treatment, care and support. This study addresses critical barriers to MSM accessing HIV testing and treatment by exploring the acceptability, feasibility, and a potential peer-driven distribution model of HIV self-testing among MSM in Nigeria.