Department of Maternal and Child Health Nursing, Faculty of Nursing, College of Medicine, University of Ibadan, Ibadan, NigeriaNigeria
Department of Clinical Nursing, University College Hospital, Ibadan, NigeriaNigeria
Also available as PDF (figures and tables appear in the PDF).
Background : HIV self-testing (HIVST) is an innovative strategy designed to expand access to HIV testing by allowing individuals to test privately and conveniently, thereby addressing stigma, time constraints, and limited access to facility-based services. Despite its potential, uptake among rural populations in Nigeria remains unclear. This study assessed the uptake of HIV self-testing and factors influencing its utilization among rural dwellers in Ibadan, Oyo State, Nigeria. Methods : A cross-sectional descriptive quantitative design was employed among 218 adults selected through multistage sampling from Ajibode (Akinyele LGA) and Omi Adio (Ido LGA). Data were collected using an adapted structured questionnaire with established validity and reliability (Cronbach’s α > 0.70). Analysis was conducted using SPSS version 27. Descriptive statistics summarized uptake levels, while chi-square tests and logistic regression identified associated factors and predictors at a 0.05 level of significance. Results : Results revealed extremely low uptake of HIVST, with only 7.8% of respondents having ever used a self-testing kit. Overall, 91.3% demonstrated low uptake based on composite scoring. Major barriers included lack of knowledge on kit use, distrust of results, preference for facility-based testing, and poor accessibility. However, 66.5% expressed willingness to self-test if kits were readily available. Education was the only sociodemographic factor significantly associated with uptake (χ² = 5.151, p = 0.047). Logistic regression identified significant predictors including planning for the future/health responsibility (AOR = 3.362, p = 0.006), encouragement from sexual partners (AOR = 2.545, p = 0.013), and peer encouragement (AOR = 2.384, p = 0.016). Age, gender, employment status, and number of sexual partners were not significantly associated. Conclusion : HIV self-testing uptake among rural dwellers in Ibadan is markedly low despite high willingness. Improving health education, strengthening trust, expanding kit accessibility, and leveraging social support networks are essential to enhance HIVST adoption in rural Nigerian settings.
Keywords: HIV Prevention; Rural community; HIV testing; Nigeria; Health education; HIVPrevention; Ruralcommunity; HIVtesting; Healtheducation
HIV self-testing (HIVST) is an alternative HIV testing approach that allows individuals to collect specimens,performthetest,andinterpretresultsprivately, therebyaddressingkeybarrierssuchasstigma,cost, andtimeassociatedwithfacility-basedtesting[1].AlthoughtheWorldHealthOrganizationhasreported increasingglobaladoptionofHIVST,implementation anduptakeremaindisproportionatelyconcentrated in upper-middle- and high-income countries [1]. In low-andmiddle-incomesettings,particularlyinsub- SaharanAfrica,factorsinfluencingtheuptakeofHIV self-testingremaininadequatelyunderstooddespite recenteffortstoimproveaffordabilityandaccess[2].
HIV testing ratesamong rural dwellers in Nigeria remaincriticallylowdespitetheirincreasedvulnerabilitytoHIVinfectionduetoriskysexualpractices,genderinequality,andlimitedaccesstohealthservices [3].WhileHIVself-testinghasthepotentialtoexpand testingcoverage,uptakevarieswidelyacrossAfrican settings,andevidenceondeterminantsofHIVSTuse among rural populations in Nigeria is scarce. This study, therefore, aimstoexaminetheuptakeofHIV self-testingandidentifyfactorsinfluencingitsutilizationamongruraldwellersinIbadan,OyoState,Nigeria.
Empiricalevidencefromsub-SaharanAfricademonstratesthatuptakeofHIVself-testingremainsvariable butgenerallymoderate,withreportedlevelsranging from25.4%inSouthAfricatoover59%inEthiopia,despiteconsistentlyhighacceptabilityandwillingnessto self-testacrosspopulations[4,5].Studieshaveshown thatuptakeofHIVSTissignificantlyinfluencedbysociodemographicfactors,includingage,gender,educationalattainment,employmentstatus,priorHIVtestingexperience,andknowledgeofHIVST,withyounger, moreeducated,andpreviouslytestedindividualsbeingmorelikelytoutilizeself-testingservices[6,7].Contextualandstructuralbarrierssuchasstigma,confidentialityconcerns,costoftestkits,limitedavailability,andweaklinkage-to-caremechanismshavealso beenidentifiedaskeydeterminantslimitinguptake, particularlyamongmenandruralpopulations[8,9]. Additionally,emergingevidenceindicatesthatsocial contextandbehaviouralfactors,includingsexualpractices,livingarrangements,andpublichealthdisruptionssuchastheCOVID-19pandemic,cansignificantly shapeHIVSTuptakepatterns,underscoringtheneed forflexible,targeted,andcontext-specificHIVSTdeliverystrategies[10].
Across-sectionaldescriptivequantitativedesignwas employedtoexaminetheuptakeofHIVself-testingand factorsinfluencingitsuptakeamongruraldwellersin Ibadan,OyoState,Nigeria.Thestudywasconducted inAjibode(AkinyeleLGA)andOmiAdio(IdoLGA),two ruralcommunitiescharacterizedbylimitedaccessto HIVtestingservicesandhealtheducation.
Thestudyincludedadultruralresidentsaged18years andabovewhohadresidedintheselectedcommunitiesforaminimumoftwoyearsandconsentedto participate.ExclusioncriteriaincludedinabilitytocommunicateinEnglishorYoruba,cognitiveimpairment, criticalillness,andpriorparticipationinsimilarHIVST studies.SamplesizedeterminationfollowedCochran’s formula,resultinginafinalsampleof218respondents after adjusting for non-response. A multistage samplingtechniquewasutilized,involvingpurposiveselectionofLGAs,randomselectionofruralcommunities, stratificationofhouseholdsintowomen,youth,and menclusters,andrandomselectionofoneeligibleparticipantperhousehold.
DatawerecollectedusinganadaptedstructuredquestionnairebasedonvalidatedHIVSTinstruments.For thismanuscript,SectionsA,C,andDofthequestionnaire were analyzed. Section C assessed uptake of HIVself-testing,includingprioruse,frequencyoftesting,andwillingnesstoself-test. SectionDexamined factorsinfluencinguptake,suchasaccessibility,cost, healthcareproviderrecommendation,religiousinfluence,fear,andeducationalexposure.Responseswere primarilydichotomous(yes/no),withsomedescriptive items. Trainedresearchassistantsadministeredthe questionnairethroughface-to-faceinterviewsinprivatesettingstoensureconfidentialityandaccuracyof responses.Completedquestionnaireswerereviewed immediatelyforcompleteness.
Instrumentvaliditywasensuredthroughexpertreview andcomparisonwithsimilarstudies.Translationand back-translationprocedureswereconductedforthe Yoruba version. A pilot test conducted among rural residentsinEgbedaLGAproducedCronbach’salpha valuesexceeding0.70,confirmingacceptableinternal consistency.
DatawereanalyzedusingSPSSversion27.Descriptive statisticswereusedtosummarizeuptakelevelsand influencingfactors. Uptakescoreswerecategorized intohighandlowuptakeusingthemeanscoreasacutoff.Chi-squaretestswereusedtoassessassociations betweenperceptions,awareness,anduptakeofHIV self-testing.Logisticregressionanalysiswasconducted toidentifypredictorsofHIVSTuptake,withoddsratios reportedata95%confidenceinterval.Statisticalsignificancewassetatp<0.05.
Astandardized,slickHealthCare&WellnessPhysical ExaminationBookwascompiledandintroducedduring the study. It included nine major sections designedforathoroughexaminationdescribingvarious detailsaboutdemography,clinicaltreatmentbehavior, lifestylemedicalcare,infectiousdiseasepractice,and otheraspects,suchasprogressongenitalcounselling.
EthicalapprovalwasobtainedfromtheUI/UCHEthicalReviewCommittee,andcommunityentryapproval wassecuredfromlocalleaders.Participationwasvoluntary,informedconsentwasobtained,andconfidentialitywasmaintainedthroughanonymousquestionnairesandsecuredatahandling.Noharmwasanticipatedorreportedduringthestudy.
Table1showsthesociodemographiccharacteristics ofthe218respondentswhoparticipatedinthestudy. Themajorityoftheparticipants182(83.5%)werebelow40years..Alargerproportionoftherespondents werefemale156(71.6%)andlargelysingle158(72.5%). Regardingeducation,111(50.9%)hadattainedtertiary education,meanwhiletheethnicityoftherespondents wasdominatedbytheYorubatribe121(55.5%).RegardingpreviousHIVtesting,only91(41.7%)oftherespondentshadpreviouslytestedforHIV,while127(58.3%) hadnot.
AsshowninTable2,asignificantmajority201(92.2%) oftherespondentshadneverusedanHIVself-testing kit, with only 17(7.8%) having used it once. Among thosewhohadusedtheself-testingkit,themajority 9((52%)hadtestedmorethan12monthsago,while 5(29%)haduseditwithinthepast6to12months.Only 3(18%)hadusedthekitwithinthepast6months.For thosewhohadnotusedtheHIVself-testingkit, the mostcommonreasonscitedwerethelackofknowledgeonhowtouseit40(18.3%),distrustintheresults 34(15.6%), and preference for facility-based testing 61(28%).Regardingwillingnesstoself-testifkitswere available, 145(66.5%)oftherespondentsexpressed interestinusingthekits,while56(25.7%)wouldnot considerself-testing.Themajority(91.3%)oftherural dwellershavelowuptakeofHIVSelf-TestinginIbadan (Figure1).
amongruraldwellers Table3presentsvariousfactors thatmayinfluencetheuptakeofHIVself-testing.One ofthestrongestpredictorswasplanningforthefuture, takingresponsibilityforone’shealth,orpreparingfor marriage.Respondentswhoidentifiedthismotivation wereoverthreetimesmorelikelytouseHIVself-testing comparedwiththosewhodidnot(AOR=3.362, p= 0.006).Socialinfluencesalsodemonstratedsignificant effects.Participantswhowereencouragedbytheirsex partnersweremorethantwiceaslikelytoundertake HIVself-testing(AOR=2.545,p=0.0127).Likewise,encouragementfromfriendsalsosignificantlyincreased uptake;individualsencouragedbyfriendswereover twiceaslikelytotestcomparedwiththosewhodidnot receivesuchsupport(AOR=2.384,p=0.016).
dwellersinIbadan. The chi-square analysisshowed thatthreeofthesociodemographicvariables:age(p =0.260),gender(p=0.751),andemploymentstatus (p=0.634),werenotsignificantlyassociatedwithHIV self-testinguptake.Consequently,thenullhypothesis wasretainedforthesevariables,indicatingthatuptake didnotdiffersignificantlyacrosstheagegroups,betweenmalesandfemales,orbetweenemployedand unemployedrespondents.However,thelevelofeducationdemonstratedastatisticallysignificantassociation withHIVself-testinguptake(X2 =5.151,df=2,p=0.047). Thisimpliesthateducationlevelplaysanimportant
Below40years 182 83.5 40–50years 36 16.5 51yearsandabove 0
Male 62 28.4 Female 156 71.6
Single 158 72.5 Married 55 25.2 Divorced 5 Widow 0
Primary 31 14.2 Secondary 76 34.9 Tertiary 111 50.9
Igbo 55 25.3 Yoruba 121 55.5 Hausa 42 19.2 Others 0
EmployedFull-time 82 37.6 Unemployed/Others 135 61.9
Ajibode 83 38.1 Omi 135 61.9
Yes 122 56.0 No 96 44.0
1 122 56.0 ≥2 96 44.0
Yes 91 41.7 No 127 58.3
roleininfluencingwhetherindividualsengageinHIV self-testing.
squaretestproducedavalueof1.622with1degreeof freedomandap-valueof0.203.Thisp-valueisabove the0.05significancelevel,indicatingnostatistically significantassociation. Therefore,thenullhypothesisisretained,suggestingthatthenumberofsexual partnersdoesnotsignificantlyaffectthelikelihoodof engaginginHIVself-testingamongruraldwellers. In termsofdistribution,114respondentswithonlyone sexualpartnerreportedhighuptake,comparedto85 amongthosewithtwoormorepartners.Lowuptake wasrecordedfor8individualswithonepartnerand11
0.0
2.3 0.0
0.0 withmultiplepartners.Thedifferenceinuptakeacross groupsisnotsubstantialenoughtoindicateameaningfulassociation,highlightingthatsexualbehavioralone maynotpredicttestingbehaviorsinthispopulation.
Thesociodemographiccharacteristicsareappropriate andrelevanttoitsobjectives,whichfocusonHIVselftestingamongruraldwellersinAjibodeandOmiAdio, Ibadan. The majority were under 40 years, aligning withexistingstudiesofsomeauthors[5],[10],which identifiedyoungadultsasakeygroupforHIVprevention.Femalesmadeupmostofthesample,reflecting trendsobservedbyanauthor[6]wheremaleswereless likelytoengageinHIVtesting.Theresultsrevealeda
≥4
worryingtrendofextremelylowengagementwiththis vitalpublichealthtool.Despiteglobaleffortsandnationalpoliciesaimedatpromotingself-testingasaconvenient,confidential,andscalableapproachtoincreasingHIVawarenessandcontrol,theruralpopulationin theseareashasshownminimaladoption.Thevastmajorityoftherespondentsinthepresentstudyhadnever usedaself-testingkit,whichreflectsthefindingsofan author[8],whoalsoobservedlowuptakeofHuman ImmunodeficiencyVirusself-testingamongruraland underservedpopulationsinsub-SaharanAfrica.However,whileitwasnoted[8]thatanotableproportionof participantshadatleastheardaboutself-testing,the currentstudysuggestsevengreaterlevelsofdetachment,notonlyinusebutalsoingeneralknowledge, regardingHumanImmunodeficiencyVirusself-testing procedures, tools, and access points. Among those whohadusedself-testingkitsinthisstudy,themajorityhaddonesomorethanayearago,withonlyafew reportingrecentuse. Thisalignswithfindingsfrom an author [4], who acknowledged that even among populationswithaccesstoself-testingkits,regularand consistentuseisoftenlow.However,unlikethestudy inSouthAfrica,wherethepreferencetiltedstrongly Frequency(N) Percentage(%)
17 7.8 201 92.2
3 18 5 29 9 52
2 12 6 35 4 23 5 29
40 18.3 5 2.3 34 15.6 6 2.8 61 28.0 8 3.7 47 21.6
145 66.5 56 25.7
infavorofself-testing,respondentsinruralIbadanexpresseddistrustintheresultsofthekitsandapreferenceforfacility-basedtesting.Thiscontrastssharply withthefindingsbysomeauthors[11],[12],whosuggestedthatHIVself-testingcouldeffectivelydecentralize HIV services, increase participation, and reduce testing-relatedstigma,especiallyinhard-to-reachcommunities. The reasons cited by the respondents for notengaginginHIVself-testing,suchaslackofknowledgeonhowtousethekits,fearofinaccurateresults, andgeneralpreferenceforclinic-basedtesting,underscorestructuralandinformationalgapsinpublichealth communicationandservicedeliveryinruralNigeria. Thesebarriersalignwiththosehighlightedbyanauthor[13],whoemphasizedthatsuccessfuluptakeof HumanImmunodeficiencyVirusself-testingrequires notonlyavailabilitybutalsoculturallysensitivehealth educationandusersupportmechanisms.Interestingly, thepresentstudyshowsthatalargeproportionofrespondents are willing to self-test if the kits become morereadilyavailable.Thisreflectssimilarfindingsby anauthor[14]and[8],whoreportedthateveninsettingswithlowcurrentuptake,thereexistsalatentwillingnessamongindividualstoadoptself-testingifbar-
Wereyouencouragedby Yes 64(29.4) yourreligiousgathering? No 154(70.6) WasaccessibilitytoHIV Yes 111(50.9) self-testingkitsafactor? No 107(49.1) Didadvicefroma healthcareprovider influenceyourdecision?
Wasfearofpossible Yes 67(30.7) exposuretoHIVafactor? No 151(69.3) Didplanningforthefuture, takingchargeofyourhealth, Yes 86(39.4) orgettingmarriedinfluence No 132(60.6) yourdecision?
Wereyouencouragedby Yes 44(20.2) yoursexpartner? No 174(79.8) Wereyouencouragedby Yes 57(26.1) yourfriends? No 161(73.9) Wasemploymentortravel Yes 37(17.0) areasonforuptake? No 181(83.0) Didtheneedtodonate bloodinfluenceyour decision?
Wascuriosityafactor?
WasthecostofHIV Yes 69(31.7) self-testingkitsafactor? No 149(68.3) Wereeducationalefforts Yes 71(32.6) areasonforyourdecision? No 145(66.5)
Table 4. Associationbetweenthesociodemographicfactors(levelofeducation,sex,andemploymentstatus)and theUptakeofHIVSelf-Testing
Age <20 20-30 4.016 3 0.260 NotSignificant 30-40 >40years Gender Male 0.101 1 0.751 NotSignificant Female Education Primary Secondary Tertiary Employment Employed 0.912 1 0.634 NotSignificant Unemployed
1.857 .379 3.616 1.170 .785
1.361 .311 3.494 1.042 .946
Yes 94(43.1) 2.446 .430 4.484 1.389 .050 No 124(56.9)
2.188 .468 4.379 1.432 .529
3.740 .933 12.117 3.362 .006
3.293 .766 8.464 2.545 .0127
3.593 .708 8.019 2.384 .016
1.864 .108 2.060 .472 .318
Yes 41(18.8) 2.163 .348 4.585 1.262 .723 No 177(81.2)
Yes 80(36.7) 2.591 .560 6.089 1.846 .314 No 138(63.3)
.996 .111 1.383 .392 .145
1.989 .169 2.282 .622 .474
47 3 89 10 28 5 35 1
56 6 143 13
30 1 65 11 5.151 2 0.047 Significant 104 7
73 9 126 10 Numberof LevelofUpatake sexual partners
1 114 8 2 85 11 Total 199 19
rierssuchascost,access,andtrustcanbeaddressed. Thewillingnessinthecurrentstudypopulationsuggestsuntappedpotentialforfutureinterventionsand signalsthatstrategicinvestmentinkitdistributionand health literacycampaignsmayyield meaningfulimprovements.Moreover,thedeclineinrecentusageof self-testingkitsobservedinthisstudymayalsofind partialexplanationinthebroaderpatternsseenduringtheCOVID-19pandemic,asdescribedbyanauthor [10].TheirstudynotedthatHumanImmunodeficiency Virusself-testinguptakedecreasedamongvulnerable groupsduringthepandemic,duetolimitedoutreach, movementrestrictions,andshiftinghealthpriorities. Whilethecurrentstudydoesnotdirectlyattributethe declineinrecentusetopandemic-relatedfactors,the timingofthelasttestingandthedrop-offinrecentengagementsuggestthatsimilardisruptionsmayhave occurredintheIbadancontextaswell.Anothercritical implicationofthecurrentfindingsistheroleoftrust inhealthtechnologies. Thesignificantproportionof participantswhodonottrusttheself-testresultsrevealsapsychologicalandsystemicbarrierthatextends beyondphysicalaccessibility.Thisalignswithbroader findingsintheliteraturewherepreferenceswerefound forsupervisedorsemi-supervisedHIVself-testingin manycommunitiesduetouncertaintyandfearassociated with handling medical results independently [15].Therefore,inadditiontodistribution,effectiveuptakeinIbadanandsimilarcontextswilllikelydepend onmodelsthatincludecounseling,community-based demonstration,andpeerengagement.Furthermore, the current preference for facility-based testing, despitethegreaterconvenienceofself-testing,illustrates thedeep-rootedbeliefintraditionalhealthcarestructures.Whileself-testingispositionedgloballyasatool forempowermentandprivacy,incontextswhereformalhealthcareinteractionsareconsideredmorelegitimate,theshifttoself-directedtestingmayrequire greaterculturaladaptationandhealthsystemendorsement[16]. Takentogether,thesefindingssignalthat whileglobaltrendsshowpromiseinHumanImmunodeficiencyVirusself-testingasatransformativetool,the Ibadancontextillustratesthatuptakeremainshighly conditionalonlocalawareness,healthbeliefs,social Chi- pdf Remark square value High Low Uptake Uptake Not 1.622 1 0.203 Significant
trust,andthepresenceofusersupportsystems.This callsforadifferentiatedapproachtointerventionplanning.Itisnotenoughtosimplydistributeself-testing kits;thestrategiesmustalsoincludetrainingprograms, trust-buildingefforts,andcommunity-levelsensitizationcampaignsthatdemystifytheprocessandaddress thespecificpsychologicalandculturalconcernsraised byruralresidents.Theprominenceofaccessibilityin thepresentstudyechoesthefindingsofsomeauthors [17],whoidentifiedlimitedaccesstoself-testkitsas amajorbarriertouptakeamongmeninNairobi.Similarly,inNorthwestEthiopiaitwasnoticedthatprior urbanresidenceandhighereducationalattainment, bothproxiesforbetteraccesstohealthresources,were significantlyassociatedwithincreasedHumanImmunodeficiencyVirusself-testinguptake[15].Thisconvergenceunderscoresthatphysicalaccessandlogistical conveniencearefoundationalprerequisitesforscaling upself-testing,particularlyingeographicallyisolated orunderservedcommunitieslikeAjibodeandOmiAdio. Healthcareproviderencouragementalsoemergedas asignificantfacilitatorinthecurrentstudy. Thisobservationalignswithpreviousworkofanauthor[18], whonotedthatparticipantsoftencitedhealthreasons andprovideradviceasmotivatingfactorsfortesting. Suchencouragementnotonlyvalidatesself-testingas amedicallyacceptablepracticebutalsohelpsalleviatedoubtsaboutitsreliability.Inacontextwheredistrustoftheresultsofself-testingkitswaspreviouslyreportedbyrespondents,endorsementbytrustedmedicalpersonnelbecomesapowerfulenablingfactor.Religiousencouragementwasalsoidentifiedasamodest, yet notable, influence on uptake. This finding complementsanauthor[23],whoemphasizedtheroleof faith-basedcommunitiesas"nurturers"inpromoting HumanImmunodeficiencyVirustestingbehaviors.The implicationisthatreligiousleadersandinstitutions couldserveaseffectivepartnersindisseminatingaccurate information and normalizing HIV self-testing, especiallyinconservativeruralsettingswherestigma maystillprevail. Educationalefforts,suchasawarenesscampaignsandinstructionalsupport,werealso recognizedbyrespondentsasinfluencinguptake.This agreeswiththefindingsofsomeauthors[19][20],who assertedthatindividualswithhigherlevelsofeducationaremorelikelytoengageinHIVtesting,owingto theirabilitytodistinguishbetweenfactsandmythssurroundingHumanImmunodeficiencyVirus.However, therelativelylowinfluenceattributedtoeducationin thecurrentstudymayreflectpersistentgapsinhealth literacy,pointingtoaneedformorelocalizedandculturallysensitiveeducationalinterventions.Costwas alsocitedasafactor,thoughnotthemostsignificant. Thisnuanceparallelsfindingsfromastudybyanauthor[6], whereonlyasmallfractionofrespondents identifiedcostasabarrier.However,itisimportantto considerthatwhilecostmaynotbetheprimaryobstacleforsome,itspresencecompoundsotherbarriers, especially in communities with widespread poverty andlimitedaccesstosubsidizedhealthcare.Socialinfluence,particularlyfromsexualpartnersandpeers, waslessfrequentlycitedinthecurrentstudy. Thisis in contrast to a study by an author [23], who found peersupportandfamilyinfluencetobemajor"nurturers"ofHumanImmunodeficiencyVirusself-testing uptakeamongNigerianyouths. Thelowerinfluence observedinthisstudymightbeattributedtotheconservativesocialenvironmentinruralIbadan, where discussionsaboutHIVandsexualhealthremaintaboo. Thishighlightsaculturalgapinsocialhealthcommunicationthatmustbebridgedthroughsensitization andtrust-buildingstrategies.FearofpossibleHIVexposurewasanothermotivatingfactoridentifiedbyrespondents,supportingpreviousresearchbyanauthor [21]thatunderscoredtheroleofperceivedriskinmotivatingearlytestingbehaviors.However,fearoperates dually;itcandrivetestinginsomewhiledeterringit inothersduetostigmaorfearofidentitychange,as notedbyanauthor[20].Therefore,whilefearmayspur curiosityandpromptactionamongasubsetofindividuals,broaderpublichealthmessagingmustshift theemotionalnarrativetowardempowerment,rather thandread.Thecurrentfindingsalsoreinforcedemographictrendsseeninpaststudies.Forinstance,some authors[6][19]notedthatmalesandunmarriedindividuals,particularlytheyoungerdemographic,tend toshowlowertestingratesdespitehavingahighrisk ofexposure.Whilethepresentstudydidnotdisaggregatefindingsbygenderoragegroup, theidentified barriers,suchaslackofencouragement,cost,andmisinformation,alignwiththosedisproportionatelyaffectingthesegroupsinpriorresearch. Thestudyinvestigatedwhethersociodemographicfactorsinfluenced HIVself-testing.Theregressionanalysisshowedthat onlyeducationlevelhadastatisticallysignificantassociationwithuptake.Individualswithhighereducation weremorelikelytoengageinself-testing,aligningwith someauthors[5][19],whodemonstratedthateducationenhanceshealthliteracyandproactivehealthbehaviors.Conversely,age,sex,andemploymentstatus werenotsignificantlyassociated,whichdiffersfrom findingsinstudiesbysomeauthor[6][18],whereemployment and younger age groups were strong predictors. The lack of significance here could suggest culturalorcommunity-levelfactorsthatmoderatethe influenceofthesedemographicsintheIbadancontext.
Thefindingdivergesfromtheassumptionsinastudyby anauthor[22],wholinkedhigh-risksexualbehaviors withahigherlikelihoodofHIVexposureandtesting.It alsocontradictsstudiesthatsuggestriskperception, ofteninfluencedbymultiplesexualpartners,canmotivatetesting.Thelackofsignificanceheremaypointto alow-riskperceptionornormalizationofmultiplepartnershipsinruralcommunities,asnotedbyanauthor [24],wheremaritalandculturalnormsaffectsexual behaviorsandattitudestowardHIV.Educationplausiblyoperatesasanupstreamenablerthatraiseshealth literacy,proceduralconfidence,andnavigationskills, therebyloweringthepracticalandpsychologicalfrictionsofself-testing;itseffectcanalsosubsumeormediatetheapparentinfluenceofotherdemographics. Ifbetter-educatedparticipantsarealsomoreexposed tohealthinformation,digitallyconnected,orfamiliar withpharmaciesandcommunityprograms,theireducationmaycapturetheseadvantagesinthemodel, leavingage,sex,andemploymentstatusstatistically muted.Asecondpossibilityisreducedbetween-group variability: ifkitaccessandmessagingwerebroadly availableacrossthestudycommunities,programequitymayhavecompresseddifferencesbyageandsex. Measurementchoicescanmatteraswell,coarsecategoriesforageoremployment(e.g.,employedvs.unemployedwithoutdistinguishinginformalwork,students, orunderemployment)andlimitedsamplesizereduce powertodetecteffectsandcanmaskcurvilinearorinteractionpatterns(forexample,youngeragepredicting uptakeonlyamongthosewithsecondaryeducationor higher).Finally,localculturalnormsinIbadan—suchas partnerorpeerinfluencecuttingacrossage/sexlines, orwidespreadinformalemploymentthatweakensthe usual“employment→access”pathway,maymoderateassociationsobservedelsewhere. Programmatically,theimplicationistomakeeducation-sensitive enablementtheprimarylever. Interventionsshould tailormaterialstolow-literacyaudiences:pictorialinstructions,shortvernacularvideowalk-throughs,and communityhealthworkerdemonstrationsthatbuild self-efficacy. Clear next-step pathways for reactive results(wheretogo, whattoexpect)canfurtherreducecognitiveload.Becauseageandsexdidnotdifferentiatebehaviorhere,broad,non-stigmatizingdistributionthroughuniversaltouchpointssuchasthe markets,religiousgatheringsopentoallgendersand ages,transporthubs,andpharmaciesmaybemore efficientthannarrowlytargetingyouthormen/women. Atthesametime,educationcanbepairedwithrelationalcuesshownelsewhereinyouranalysistomatter(partner/friend/providerprompts),ensuringthat knowledgetranslatesintoaction.Formonitoring,track behavior-proximalindicators(confidenceinperforming the test, knowledge of where to get a kit today) alongsideeducationleveltoidentifyandclosegaps.
Thisstudyprovidesempiricalevidenceofextremely lowuptakeofHIVself-testingamongruraldwellersin AjibodeandOmiAdiocommunitiesinIbadan,despite arelativelyhighwillingnesstouseHIVself-testingkits iftheyaremadeavailable.ThefindingsrevealasubstantialgapbetweenthepotentialofHIVself-testingas apublichealthinnovationanditsactualutilizationin ruralNigeriansettings.Keybarrierstouptakeincluded limitedknowledgeonhowtousethekits,distrustin testresults,preferenceforfacility-basedtesting,and pooraccessibility.Educationemergedastheonlysociodemographic factor significantly associated with HIVself-testinguptake,underscoringthecentralrole ofhealthliteracyinenablingindividualstoadoptselfdirectedhealthtechnologies.Socialandmotivational factors—suchasplanningforthefuture, encouragement from sexual partners and friends, and healthcareprovideradvice—weresignificantpredictorsofuptake,highlightingtheimportanceofinterpersonaland community-levelinfluences.Conversely,age,gender, employment status, and number of sexual partners werenotsignificantlyassociatedwithuptake,suggestingthatcontextualandstructuralfactorsmayoutweigh individualriskbehaviorsinshapingHIVtestingdecisionsinthispopulation.Overall,thefindingssuggest thatwhileHIVself-testingholdspromiseforexpanding HIVtestingcoverageinruralcommunities,itseffectivenesswillremainlimitedwithoutdeliberateeffortsto improveaccess,buildtrust,strengthenhealtheducation,andintegratesocialsupportmechanisms.These resultscontributetothegrowingbodyofpublichealth evidence emphasizing the need for context-specific strategiestooptimizeHIVself-testingimplementation inlow-resource,ruralsettings.
Thefindingsofthisstudyhaveimportantimplications forpublichealthpractice,policy,nursing,andfuture research. First,thereisacriticalneedtostrengthen community-basededucationandsensitizationonHIV self-testing, with a focus on improving procedural knowledge,addressingmisconceptionsabouttestaccuracy,andclarifyinglinkage-to-carepathwaysfollowingareactiveresult.Educationalinterventionsshould betailoredtoindividualswithlowereducationalattainmentthroughtheuseofpictorialinstructions,demonstrations,andculturallyappropriatemessagesdelivered in local languages. For public health programming,improvingthephysicalavailabilityandaffordabilityofHIVself-testingkitsinruralcommunitiesis essential. Distributionstrategiesshouldleverageexistingcommunitystructuressuchasprimaryhealthcare centers, pharmacies, markets, religious institutions,andcommunityoutreachprogramstoensure equitable access. Given the significant influence of healthcareproviderencouragement,traininghealth workers—particularlynursesandcommunityhealth extensionworkers—toactivelypromoteanddemonstrateHIVself-testingisstronglyrecommended.Their endorsementcanenhancetrust,normalizeself-testing, and bridge the gap between self-testing and formal healthcareservices. Thestudyalsounderscoresthe importance of social and relational influences. Interventions should incorporate partner-, peer-, and community-ledapproachesthatencouragedialogue aroundHIVtestingandreducestigma.Engagingcommunityleadersandfaith-basedorganizationsasadvocatesmayfurtherenhanceacceptanceanduptakein conservativeruralcontexts.Intermsofnursingpracticeandeducation,thefindingshighlighttheneedto integrateHIVself-testingeducation,counselingskills, andcommunityengagementstrategiesintonursing curricula and continuing professional development. Nursesaretoserveaseducators,facilitators,andlinkageagents,ensuringthatindividualswhoself-testare supportedthroughoutthetestingandcarecontinuum. Fromapolicyperspective,stakeholdersshouldprioritizetheinclusionofHIVself-testingwithinnational andstate-levelHIVpreventionstrategies, withclear guidelinesoncommunitydistribution,qualityassurance,andlinkage-to-caremechanisms.Policiesshould alsoaddresstrust-buildingmeasures,includingpublicvalidationofHIVself-testingaccuracyandsafety. Finally, future research is recommended to explore qualitativeperspectivesontrust,stigma,anddecisionmakingaroundHIVself-testinginruralpopulations,as wellasinterventionstudiesassessingtheeffectiveness ofeducation-focusedandcommunity-drivenHIVselftestingmodels.Longitudinalandmixed-methodsstudiescouldfurtherelucidatehowwillingnesstranslates intosustaineduptakeovertime. Collectively, these actionscanenhancetheroleofHIVself-testingasa scalableandacceptabletoolforimprovingHIVtesting coverageandadvancingHIVpreventiongoalsinrural Nigeriaandsimilarsettings.