A Comparative Study of the Psychological Risk Factors Between Hiv Self-testing and Facility Based Testing at Kenyatta National Hospital in Kenya

Abstract

Background: HIV self-testing (HIVST) was rolled out in the country in May 2017 with the aim of reaching the hard-to-reach population such as men. It is the process whereby a person conducts an HIV rapid diagnostic test and interprets the result in privacy by herself or himself. HIV self-testing (HIVST) does not include the component of counseling which is a vital component of HIV testing. There is a perceived increased risk of unmanaged anxiety, with the potential for suicide caused by the inability of clients to psychologically cope with the possibility of reactive results. Study objective: The main objective of the study was to identify the psychological risk factors between HIV self-testing (HIVST) and Voluntary Counseling and testing among clients attending Kenyatta National Hospital (KNH). Methods: Analytical cross-sectional design was used in which data on clients’ experience regarding HIV self-testing (HIVST) and Voluntary Counseling and testing was collected. Clients were screened for anxiety, depression and suicidal symptoms using the Beck depression, anxiety, and suicide inventory tool. Fisher's formula was used to calculate the study sample sized based on the data reported in KHIS on HIVST. Simple random sampling criteria were used to sample patients seeking HTS at KNH VCT. Descriptive statistics such frequencies and percentages were used to analyze collected data in line with formulated study objectives. Spearman correlation was used to measure the relationship between demographics and mental health outcomes. The findings were presented inform of charts and tables and heat maps. Results: The study involved 139 clients seeking HTS service, of whom the majority 87(62.6%) opted for facility based HTS modality. Participants with diploma and graduate education level showed the highest preference of HIVS. Married clients were not to majorly prefer HIVST over the ordinary facility based HTS modality. Those who had previously used showed the highest preference of HIVST. The prevalence was2(3.8%) and 4(4.6%) and among clients who used HIVST and Facility based HIV testing modality, respectively. Depression was high among clients who opted for facility-based HIV testing at 10.3% in comparison to 3.8% among those who opted for HIVST. The prevalence of suicidal ideation was 3.4% higher in clients seeking facility-based HIV testing as compared to clients opting for HIVST. Gender showed very weak correlation with mental health outcomes among both populations as indicated depression (HIVST: r = -0.04, facility based: r = 0.16), anxiety (HIVST: r = 0.07, facility based: r = 0.16) and suicidal tendencies (HIVST r = 0.07, facility based HTS: r = 0.16). Age as factor had weak correlation with depression (HIVST: r = 0.07, facility based HTS: r = 0.16), anxiety (HIVST: r = 0.07, facility based HTS: r = 0.000) and suicidal ideation (HIVST: r = 0.07, facility based HTS: r = 0.16). Very weak correlation in

both those opting for HIVST and those preferring facility-based modality depression (HIVST Modality: r = -0.01, facility-based modality: r = -0.09) in education. Prior use of HIVST had weak positive correlation in both groups (facility based: r = 0.05, HIVST: r = 0.21). Conclusion: The study marital support which came out as protective factor for both anxiety, depression, and suicidal tendencies in both study groups. Age, gender, education level and religion showed weak relationship with mental health outcomes. Prior use of HIVST was positively correlated with mental health issues outcomes. The findings point to the need to customize targeted psychological support for clients opting for HIVST modality.