HIV self-Testing (HIVST) using oral fluid is a method of HIV testing in which a person obtains a specimen of his/her own oral fluid to perform HIV self-test and evaluates the results 1. As with all approaches to HIV testing, HIVST should always be voluntary, not coercive or mandatory 2. The potential benefits of HIVST include increased access to testing and earlier diagnosis for people living with HIV. People who self-test also experience greater convenience, autonomy and privacy when testing 3.
To reduce the epidemics of HIV, UNAIDS have set goals and strategies to achieve those goals. According to UNAIDS, 95% of people within sub-population who are living with HIV will know their status by 2030 4. HIV self-testing services are essential for accomplishing the first UN goals 95-95-95 goals by 2030 5. It is a new strategy that gives people the chance to test themselves inconspicuously and easily 6.
HIV self-testing (HIVST) is recommended by the World Health Organization (WHO) as a strategy to overcome the barriers many individuals face to learning their HIV status and accessing lifesaving HIV treatment and prevention services 2 and It is an important complement to other testing strategies 7. Many nations are now adopting self-testing programs to some extent after having policies that permit it 8. HIVST can provide up preferred paths for people who might not otherwise receive services owing to worries about convenience, confidentiality, stigma, and discrimination 7.
According to UNAIDS Spectrum report, the number of PLHIV in Ethiopia is estimated to be 665,723. According to estimates, only 79.0% of adults (ages 15 to 64) had knowledge of their HIV status 9. In order to identify HIV infection among the important population groups, HIVST is one of the recommended new case detection tools by FMOH of Ethiopia 1.
HIV infection is among major public health concerns 10. According to UNAIDS Global AIDS Update, 4000 people become infected with HIV every day. If current trends continue, 1.2 million people will be newly infected with HIV in 2025 11. HIV/AIDS disease burden and risk factors vary by region. The vast majority of people with HIV are in low and middle income countries 12. In 2019, there were 863, 840 deaths 13, while the number of AIDS-related deaths have been reduced to 650,000 in 2021 globally 12.
Globally, important gaps in the achievement of the 90-90-90 targets were shown for men and young adults (aged 15–24 years), where treatment coverage among men (68% (54%-83%) is also lagging behind coverage for women (79% (61%-95%) due to many are not reached. In addition, ART coverage among young adults aged 15–24 in 2020 is estimated to be 55% compared to 75% among those over 25 years of age which is due to poor first’s 95 achievements 14.
In addition to morbidity and mortality, HIV/AIDS has been affecting the world financially. The global expenditure on HIV pharmaceuticals in 2019 was 28 billion dollars 15. In Ethiopia, around 609,349 people have been living with HIV in 2022. In addition, the annual AIDS-deaths were estimated to be 10,42116.HIV/AIDS have been affecting the health system by enforcing increasing health spending on the prevention and treatment of the disease. With regard to this, a significant share of health spending (49%) goes to prevention, management, and treatment of infectious and parasitic diseases and of this amount, nearly 10% goes to HIV/AIDS in Ethiopia 17.
It will be challenging to meet the United Nations' first 95 targets for 2030, the first of which is diagnosing 95% of all HIV-positive individuals, without additional scaling up of measures that make HIV testing services more accessible and desirable to those in need 18.To achieve the triple 95% target, the global HIV response must close the testing gap and identify 95% of all HIV-positive individuals by 2030. However, only 79% of Ethiopians and 54% of people worldwide who live with HIV are aware of their status. Increased usage of HIVST can help achieve these worldwide goals 19.
The acceptance of HIV self-test varies across the countries. According to study on acceptability of HIV self-testing, the global acceptability rate ranged from 22–87% 20. Studies revealed that the acceptability HIVST was 64.6% in Indonesia that 21, 81.4% in Democratic Republic of the Congo 22, 82.4% in Rural Zimbabwe 23, 19% in Kenya 24, 65.3% of individuals felt at ease using the oral-fluid HIV test in Tanzania 25, 70.4% in Northern Nigeria 26 and varies from 22.3–94% in Sub-Saharan Africa 27.
Different factors were known to affect the acceptance of HIV self-testing. Among these, age of individual 23, being female 24, being male 26,27, level of education 24,ever tested for HIV 28, ever utilized any HIV test services 29, having sexual partner 29, multiple sexual partner 25, not using condom 26,30, professional counseling 31,32, issue of privacy and confidentiality within the health care facilities 31
Despite the government’s effort of availing HIV test, the proportion of people who have been tested and received their results were low 33. To solve the low test coverage and treatment, Ethiopia has adopted UNAIDS three 95’s,to attain 95% of PLHIV knowing their HIV status and linked to care by 2030 34. In addition, Ethiopia adopted WHO HIVST to clinic-based HTS which can increase coverage and frequency of HIV testing, including those less well served by established HTS approaches, such as rural populations, men, young people, and key populations 7.
Even though the acceptances of HIVST and associated factors have been identified in former studies, the focuses of the former studies were mostly on special populations such as health care workers, students and sex workers. However, there is inadequate information on the acceptance of HIVST and associated factors among targeted adult population in general. Therefore, the aim of this study was to fill gap in the study topic by assessing acceptance and associated factors of HIV Self-test among targeted adult clients using oral fluid in the study area.