HIV counsellors' knowledge and attitudes on HIV self-testing: A qualitative study in Eswatini.

Background: Human Immunodeficiency Virus (HIV) self-testing (HIVST) expands access to HIV diagnosis and holds potential for reaching high-risk and hard-to-reach populations. In Eswatini, HIV counsellors play a key role in providing HIVST, yet their knowledge and attitudes towards HIVST remain underexplored.

Aim: This study aimed to explore the knowledge and attitudes of HIV counsellors in offering HIVST as a strategy to enhance targeted HIV services in Eswatini.

Setting: The study was conducted at the outpatient department of a regional hospital in Manzini, Eswatini.

Methods: A qualitative, exploratory-descriptive research design was used. HIV counsellors were sampled using all-inclusive sampling. Individual, face-to-face semi-structured interviews were conducted with 13 HIV counsellors. The interviews were audio-recorded and transcribed. Data were thematically analysed.

Results: HIV counsellors demonstrated a comprehensive understanding of their roles and responsibilities in delivering HIVST and expressed generally positive attitudes towards this testing approach. Recommendations were made for improving HIVST.

Conclusion: The findings highlight the need for policymakers to prioritise the continuous professional development of HIV counsellors and equip them with strategies including mobile testing units and community-based HIVST distribution to reach marginalised high-risk populations within their specific area. Service delivery should integrate effective client feedback systems to improve HIVST, a continuously available support contact line, and government commitment to ensure consistent HIVST kit supplies to prevent disruptions in service delivery.

Contribution: This study describes HIV counsellors in Eswatini's knowledge and attitudes towards HIVST in Eswatini.