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Page 4 of 7 Original Research

analysis. Data were grouped into categories to define the testing steps as outlined in the app (Table 3). Almost all of
demographic characteristics, then presented as frequency the difficulties were related to the self-testing procedures, as
counts and percentages. 18 (6.0%) participants had difficulty sliding the tube into the
stand, eight (2.7%) had difficulties swabbing their gums and
Ethical consideration three (1.0%) stated that the instructions were not clear.
Another four (1.3%) participants had difficulty taking and
Ethics approval was obtained from the University of the uploading the picture of the test to the app. When asked for
Witwatersrand Human Research Ethics Committee (reference suggestions to make the app easier to use, five (1.7%)
number 180504). All participants provided informed consent participants recommended that the instructions and steps be
and were compensated ZAR150 for their time.
clarified, whilst four (1.3%) participants specifically
Results suggested adding a multimedia component to the
instructions. Another four (1.3%) participants suggested that
Demographics the app be available in local languages and two (0.7%)
participants stated that the phone memory requirements
Of the 300 participants, over two-thirds (211; 70.3%) were
younger than 36 years old, there were 134 (44.7%) female should be decreased. All but one (299/300; 99.7%) participants
participants and 231 (77.0%) participants who were educated were willing to use the app again and only two (0.7%)
up to at least high school level. Only 35 (11.7%) participants participants stated that they would not be willing to
indicated that they had previously self-tested. This download the app in the future.
information is presented in Table 1.
Feasibility
HIV test outcomes The final feasibility score was 70.0%. All 300 individuals
Forty-two (14%) participants interpreted their self-test result approached for this study agreed to participate in the
TM
as HIV positive; however, there were 5 (1.7%) discordant evaluation of the Aspect HIVST app (Table 4). Of the 300
interpretations between participants and HCWs (Table 2). participants, 267 (89.0%) successfully completed the HIVST
Three (1.0%) results were interpreted as positive by the HCW by following all of the steps on the app without error. The
but were interpreted as either invalid (1; 0.3%) or negative (2; majority of errors (26; 8.7%) came from participants
0.7%) by the participant, and 2 (0.7%) results were interpreted performing the testing procedures incorrectly, after reading
as negative by the HCW but interpreted as either the instructions on the app, which included sliding the tube
indeterminate (1; 0.3%) or positive (1; 0.3%) by the participant. into the stand (18; 6.0%) and swabbing the gums (8; 2.7%).
Manual review of these discordant test result images, on the Another four (1.3%) participants had difficulties with the
Aspect dashboard by a senior researcher, confirmed the language of the instructions, whilst eight (2.7%) participants
TM
HCW interpretation in all discordances. The confirmatory made errors interpreting their HIVST results and one
testing of all participants conclusively diagnosed 43 (14.3%) participant (0.3%) could not properly navigate the pages of
as HIV positive, all of whom were referred to care by the the app.
HCW.
Of the 267 participants who completed the testing (Table 4),
Acceptability 210 (78.7%) participants successfully captured all information
on the app. The most erroneous variable was previous testing
Nearly all participants (296/300; 98.7%) found the Aspect history, where 34 (12.7%) participants submitted information
TM
HIVST app easy to use, when surveyed; however, 26 (8.7%) that did not correlate with what they stated to the HCW
participants experienced some difficulty working through
TABLE 2: Human immunodeficiency virus (HIV) testing outcomes. Sample size = 300.
TABLE 1: Demographic characteristics. Sample size = 300. HIV test results Frequency Percentage
Demographic Frequency Percentage HIVST participant interpretation
Age HIV positive 42 14.0
18–25 years old 105 35.0 HIV negative 253 84.3
26–35 years old 106 35.3 Invalid 5 1.7
Over 35 years old 89 29.7 HIVST HCW interpretation
Sex HIV positive 43 14.3
Female 134 44.7 HIV negative 254 84.7
Male 166 55.3 Invalid 3 1.0
Highest level of education Interpretation discordance
Grade 7 or less 18 6.0 Correctly interpreted 295 98.3
Grade 8 to matric 213 71.0 Interpretation error 5 1.7
Tertiary school 69 23.0 HIV confirmatory testing
Ever self-tested before HIV positive 43 14.3
Yes 35 11.7 HIV negative 257 85.7
No 265 88.3 HIVST, HIV-self-testing; HCW, healthcare workers.

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