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Impact of HIV Self-Testing on HIV Testing Uptake among Young Adults in Nigeria

Abstract

HIV testing is a critical component of HIV prevention and control because knowledge of HIV status enables individuals to access appropriate treatment and care and adopt measures that reduce the risk of HIV transmission. However, conventional facility-based HIV testing may be underutilized by young adults because of concerns about stigma, confidentiality, inconvenient service hours, transportation barriers, fear of discrimination, and concerns about being seen accessing HIV services. HIV self-testing provides an alternative approach in which individuals collect their own specimen, perform the test, and interpret the result according to the instructions provided with the testing kit. HIV self-testing may increase privacy, convenience, autonomy, and accessibility and may therefore encourage more young adults to undertake HIV testing. In Nigeria, where young adults remain an important population for HIV prevention efforts, expanding acceptable and accessible testing approaches may contribute to increased HIV status awareness and early linkage to appropriate services. Against this background, this study investigates the impact of HIV self-testing on HIV testing uptake among young adults in Nigeria. The study will be anchored on the Health Belief Model, the Theory of Planned Behaviour, and Andersen's Behavioral Model of Health Services Use. The Health Belief Model explains health-related behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action and provides a suitable framework for understanding decisions to undertake HIV self-testing. The Theory of Planned Behaviour explains behavioural intentions through attitudes, subjective norms, and perceived behavioural control. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding how an alternative testing approach may influence HIV testing uptake. Collectively, these theoretical perspectives provide a suitable framework for explaining how HIV self-testing may influence HIV testing behaviour among young adults in Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from young adults aged 18–24 years residing in selected locations in Nigeria. A multistage sampling technique will be used to select states, local government areas, communities or institutions, and eligible participants. HIV self-testing will be assessed using indicators such as awareness of HIV self-testing, access to self-test kits, availability of testing instructions, ease of obtaining the kit, ease of performing the test, perceived privacy, convenience, willingness to use self-testing, and previous use of HIV self-testing. HIV testing uptake will be assessed using indicators such as completion of HIV testing within a defined reference period, frequency of HIV testing, use of self-testing or facility-based testing, willingness to test again, and linkage to confirmatory testing or appropriate healthcare services following a reactive self-test result. Structured questionnaires and relevant programme or testing records will be used for data collection where available. Descriptive statistics will be used to summarize participants' characteristics, HIV self-testing awareness and utilization, and HIV testing uptake patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the impact of HIV self-testing on HIV testing uptake. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that HIV self-testing has a significant positive impact on HIV testing uptake among young adults in Nigeria. Young adults who have access to HIV self-testing are expected to demonstrate greater utilization of HIV testing services than those who rely exclusively on conventional facility-based testing. The privacy and convenience associated with self-testing may reduce concerns about stigma, confidentiality, and being observed while seeking HIV services. Self-testing may also allow young adults to test at a time and location that is convenient for them, potentially reducing logistical barriers to testing. Clear instructions and appropriate support services may further improve confidence in using self-test kits. However, concerns about interpreting results, fear of receiving a positive result, lack of confirmatory testing, inadequate access to test kits, misinformation, and limited linkage-to-care systems may reduce the effectiveness of HIV self-testing. Furthermore, HIV self-testing alone may not fully determine testing uptake because individual HIV knowledge, perceived risk, stigma, socioeconomic circumstances, social norms, and previous testing experiences may also influence testing behaviour. The study is expected to contribute to the literature on HIV self-testing, HIV testing uptake, HIV prevention, young adult health, health promotion, infectious disease control, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Agency for the Control of AIDS, Nigeria Centre for Disease Control and Prevention, state ministries of health, HIV programme managers, healthcare facilities, community-based organizations, youth-focused organizations, development partners, and policymakers regarding strategies for expanding HIV testing among young adults. The study will also provide evidence-based recommendations for improving access to HIV self-test kits, strengthening public education on correct self-testing procedures, ensuring clear testing instructions, establishing accessible confirmatory testing services, strengthening linkage to HIV care and prevention services, addressing stigma and misinformation, and integrating HIV self-testing into broader HIV prevention and testing programmes across Nigeria.

Keywords: HIV self-testing, HIV testing uptake, young adults, Nigeria, HIV prevention, HIV/AIDS, self-testing, health promotion, infectious disease control, HIV status awareness, healthcare utilization, public health.