Dissemination of Αt-home HIV testing to high-risk urban African American youth: Barriers and solutions

Background: The At-home HIV test (AHT) has the potential to increase knowledge of HIV status and linkage to care globally among populations that avoid testing due to fear of stigmatization. In the U.S., many young African Americans remain untested, resulting in negative medical outcomes. Our prior work showed that untested high-risk youth favored AHT over clinic-based approaches, but research on AHT dissemination strategies is lacking.

Method: To understand the barriers and facilitators of AHT dissemination, we conducted 9 focus groups (5 youth groups; 4 provider groups), an ethnographic study of pharmacies (n = 10), and had individual providers evaluate AHT kits (n = 5). Youth were from low-income neighborhoods in Chicago and providers worked in non-clinical community-based (CBOs) agencies serving these communities.

Results: Youth and providers identified some advantages of AHT in reducing barriers to testing posed by clinic venues, especially for African American males. Furthermore, they identified multiple advantages of delivering AHT through CBOs as opposed to pharmacies (e.g., increased confidentiality, reduced stigma, lower costs), and suggested that CBOs may be able to facilitate follow-up counseling and linkage-to-care. Ethnographic data indicated that pharmacy dissemination has additional challenges (e.g., limited access, availability, competing motives). Providers emphasized the need for achieving proper fit between AHT and agency programs and goals.

Conclusions: Findings suggest that, given proper attention to fit, AHT dissemination to urban African American youth could be facilitated through distribution by non-medical CBOs. This work has global implications for the test-and-treat programs in cultures with high levels of HIV stigma.