This post was authored jointly by Tavian McKinnon, of GeoPoll and Kristen Little of PSI International.
In order to learn more about how the private sector could help increase the proportion of people in Kenya who know their HIV status, Population Services International (PSI) and Population Services Kenya (PS Kenya), with support from the Children’s Investment Fund Foundation (CIFF), launched an HIV self-test demonstration project in Nairobi and Mombasa. HIV self-tests are tests that individuals can perform and interpret themselves at a private location of their choosing, and have been shown to be highly acceptable and accurate in a wide variety of populations and settings. To increase demand for HIV self-test kits, which were new to the Kenyan market, and to better understand customer satisfaction with self-testing services, PSI and PS Kenya needed to find a way to connect with consumers directly. Fortunately, GeoPoll, a ICT company that specializes in connecting organizations with people in sub-Saharan Africa, was able to make such a connection possible.
Test Kits and Methodology
During the demonstration project, both oral-fluid and blood-based self-test kits were sold in select private-sector health facilities and pharmacies in Nairobi and Mombasa. From August 31, 2018 through March 29, 2019, GeoPoll facilitated a study for PSI to assess Kenyans’ use of and satisfaction with HIV self-test kits. The study included two SMS-based surveys on product satisfaction of the self-test kit and post-test medical care and attitudes. Unlike traditional SMS surveys, respondents opted-in to the surveys using shortcodes found in each self-test kit purchased.
After working closely with PSI to develop the questionnaires for the product satisfaction and post-test survey, GeoPoll developed thousands of unique six-digit codes to be used as an access code to the SMS surveys. A small flyer within each HIV self-test kit provided instructions to the purchaser of the kit to send an SMS message to GeoPoll’s universal shortcode in Kenya with the keyword “HIVST”. Directly after sending a SMS message with the keyword HIVST, the sender was asked to enter a unique six-digit code found in their respective self-test kit. GeoPoll’s system verified if the code matched the codes distributed with each self-test kit. If the codes matched, the sender automatically received the product satisfaction survey. Two weeks later, the same mobile number that completed the product satisfaction survey and consented to the survey received the post-test survey via SMS.
Analysis and Results
The product satisfaction survey questions assessed the individual’s purchasing and usage experience with the self-test kit. Additionally, this survey collected demographic and behavioral data on participants, including if they had ever tested for HIV previously, which type of HIV self-test kit (blood or oral fluid) they had used, where they sought test-use information, and if they would recommend HIV self-testing to friends or family members. The post-test survey evaluated if the respondent accessed confirmatory testing and/or medical treatment following their self-test, and if their post-test experience was satisfactory.
Both of these surveys helped PSI better understand consumer experiences with private sector HIV self-tests, where users seek test use information, and whether and where they access post-test care. Moreover, it provided information on how satisfied they were with their test kit purchase, use, and post-test experiences, and how likely they would be to recommend the test kits to others. Because HIV self-tests were new to Kenya, and were designed to be used by consumers in private, it was vital that PSI work to understand user experiences and post-test behavior. By utilizing SMS surveys as a tool to measure these data points, the individuals that purchased and used the self-test kits were able to provide their opinion securely and confidentially on their experience and results of their respective tests.
The findings from the surveys showed that consumer satisfaction with private sector HIV self-testing was incredibly high, and that most users would recommend self-testing to a friend or a loved one. Given that over 80% of the participants were also willing to self-report their HIVST results, and that attrition between the initial and follow-up surveys was very low, this study also provides an interesting proof-of-concept for a low-cost, private approach to monitoring linkage-to-care following self-testing (which can be challenging for self-care medical technologies more broadly). To conduct a similar survey of your own, contact GeoPoll today to get started.