Digital HIV self-testing proves unpopular with young Zimbabweans

Research from Zimbabwe into digitally-supported HIV self-testing for young people shows how important it is to understand the context of those being targeted by any new service. 

What is the research about? 

A mobile app called ITHAKA which supports HIV self-testing for young people (ages 16–24) in Zimbabwe. The app provides youth-focused HIV information, a visual demonstration on how to self-test, a way to report results, and guidance on what to do next. 

Between April and September 2019, young people using a community-based, HIV and sexual and reproductive health service in Harare were offered three different ways to test for HIV. They could get tested by a health worker at the service, they could self-test at the service using ITHAKA on a tablet in a private booth, or they could self-test elsewhere using ITHAKA on their mobile.  

Why is this research important? 

HIV testing is low among young people, even in countries like Zimbabwe where HIV prevalence is high. HIV self-testing, linked with digital technology, could be a way to close this gap. But only if it actually works for young people’s lives. 

What did they find out? 

Just under 2,200 young people agreed to an HIV test. Of these, only 6% opted for self-testing using ITHAKA.  

Of those who opted for self-testing, 85% self-tested on-site. The remaining 15% opted to self-test elsewhere.  

All young people who self-tested on site completed their test, except for one. But among those who chose to test off-site, only 47% completed their test. 

Researchers interviewed centre staff about the main problems with ITHAKA.  

(1) Technical challenges 

Network coverage was patchy and power cuts also affected use. Some young people’s phones could not download apps or connect to websites.  

(2) Low literacy, digital literacy and confidence  

Written information on how to use ITHAKA was provided in English, Shona and Ndebele. But many young people had difficulties understanding the instructions and asked providers for help. Some young people asked providers to show them how to use it, even if they felt they understood the instructions. 

One youth worker said: “We had some that opted for [self-testing] in a booth but it almost always ended up as a provider test. One would come out of the booth and try and get help from the providers, so at the end of the day it's not really a self-test because you have to go and assist.” 

(3) Testing fears  

Providers felt that young people were anxious about HIV testing, and ITHAKA did not sufficiently address their worries. Support from friendly, non-judgemental providers was seen as an essential part of HIV testing for young people. 

(4) Lack of a privacy  

Providers reported that young people often share phones with family members or friends, which would make it hard to use ITHAKA privately. Even if a young person had their own phone, providers said a lack of privacy at home meant most would prefer on-site testing. 

What does this mean for HIV services? 

Digitally-supported HIV self-testing for young people sounds like a good idea. But whether it works in reality depends on young people having internet access and their own smartphone. They also have to prefer the idea of self-testing over provider testing, and feel confident in carrying out a self-test and using a digital app.  

As this study shows, this may not be the case for all young people. This provides further evidence of the need to fully understand the context and needs of the group being targeted, or risk designing a service that will not work.