# Empowering Vulnerable Communities Through HIV Self-Testing: Post-COVID-19 Strategies for Health Promotion in Sub-Saharan Africa

## TL;DR

This paper explores how HIV self-testing can empower vulnerable communities in sub-Saharan Africa after the pandemic, highlighting barriers and strategies for effective implementation.

## Contribution

The study integrates macro-level data with community-level insights to propose equity-driven strategies for HIV self-testing in post-COVID-19 health promotion.

## Key findings

- Low awareness and uptake of HIV self-testing were observed, with education, wealth, and HIV knowledge as key predictors.
- Privacy, autonomy, and convenience were seen as major benefits of HIV self-testing, while cost and stigma were significant barriers.
- Peer-led outreach and integration into public health systems were emphasized as effective strategies for promoting HIV self-testing.

## Abstract

HIV remains a significant public health challenge in sub-Saharan Africa (SSA), with vulnerable communities disproportionately affected and further marginalised by the COVID-19 pandemic. HIV self-testing (HIVST) has emerged as a transformative, empowering tool to bridge testing gaps and promote health equity. This study examined post-COVID-19 strategies for leveraging HIVST to empower vulnerable populations and advance health promotion in SSA. Analysis was performed using secondary Demographic and Health Survey (DHS) data (2015–2022) collected across 24 SSA countries. In addition, qualitative interviews were conducted with female sex workers in Port Harcourt, Nigeria (18–31 May 2023). The study adopted an explanatory sequential mixed-methods design. Quantitative analysis using complex sample logistic regression revealed low awareness (16.3%) and uptake (2.5%) of HIVST among the 594,639 respondents. Key predictors of uptake included higher education (aOR, 7.36; 95% CI, 6.62–8.18), wealth (richest quintile aOR, 3.28; 95% CI, 2.95–3.65), and knowledge of HIV transmission (aOR, 33.43; 95% CI, 11.03–101.24). Thematic analysis highlighted privacy, autonomy, and convenience as key benefits, while cost, stigma, and fear of testing alone were major barriers. The participants emphasised peer-led outreach and integration of HIVST into public health systems as effective strategies. The findings were integrated interpretively, linking macro-level testing disparities with community-level experiences to inform post-pandemic policy and programme design. The study concludes that HIVST holds strong potential to empower marginalised groups and strengthen community-driven HIV prevention post-COVID-19, but success will depend on equity-driven policies and sustainable implementation frameworks, guided by affordability and community participation.