A theory-based behaviour change intervention to increase HIV self-testing uptake and linkage to HIV prevention, care and treatment for hard to reach populations in Northern Tanzania

Abstract

Background: HIV Self-Testing (HIVST) has the potential to circumvent barriers associated with conventional, facility-based HIV testing services. To increase the uptake of HIVST among hard to reach populations, we need effective HIVST implementation strategies based on theory and evidence. In this article, we describe the development of a behaviour change intervention (BCI) using the PRECEDE -PROCEED model; Capability, Opportunity, Motivation, and Behaviour (COM_B) model and the Behavior Change Wheel (BCW). We also describe the acceptability and feasibility of the BCI and fidelity of its implementation.

Methods: Content and delivery were informed by systematic review, qualitative syntheses and formative exploration of barriers and facilitators for uptake of HIVST among hard to reach populations in northern Tanzania. Additional inputs were received from members of a local community advisory board (CAB). An uncontrolled before-after study design was conducted between March 2018 (pre-intervention phase) and July 2018 (post-intervention phase). Acceptability and feasibility of the BCI was assessed qualitatively among ten conveniently selected participants. Fidelity of implementation was assessed using direct observation of ten-trained PEs using a pre-defined index checklist.

Results: The resulting intervention was two individual sessions delivered by ten-trained peer –educators. Participants perceived the BCI acceptable and feasible to increase HIVST uptake among hard to reach populations. Ratings for the overall intervention sessions ranged from 4.3 to 4.8(max= 5). Overall ratings on materials ranged from 4.7 to 4.8(max =5). The overall mean adherence score was 33.5(SD 3.2) ranging from 20 to 38. The overall mean performance score was 15.5 (SD 1.9) ranging from 12 to 18.

Conclusions: The present findings suggest the BCI was well acceptable among hard to reach populations and feasible in an urban setting in northern Tanzania. The BCI was implemented with moderate to high levels of fidelity by trained PEs.