Motivations for testing and linkage to HIV services following HIV self-testing among fishermen in Kenya: a qualitative analysis.

HIV self-testing (HIVST) is a promising strategy to expand testing access for hard-to-reach populations such as Kenyan fishermen. We examined motivations and barriers to HIVST use and linkage to HIV prevention and treatment services (including PrEP or ART), within a social network-based intervention (NCT04772469). We conducted interviews (N = 64) and focus group discussions (N = 4) with fishermen in Siaya County, including 30 "promoters" who distributed HIVST kits and transportation vouchers within their social networks. Transcribed interviews were coded using framework analysis with a mixed inductive-deductive codebook. Convenience, privacy and avoidance of stigma motivated HIVST uptake. Men perceiving themselves at high HIV risk were especially motivated to test, while some preferred clinic-based testing for counseling and perceived accuracy. Promoter training increased personal and peer testing motivation. Confirmatory testing was facilitated by perceived HIV risk, PrEP interest, spousal encouragement and transport vouchers offsetting travel costs. Barriers included distance to clinics, competing work priorities, mobility and the perception that confirmatory testing was unnecessary after a negative result. Gender norms prioritizing work over healthcare further impeded linkage. HIVST is a valuable tool for increasing testing among highly mobile men and its impact can be strengthened through social network-based delivery.