Exploring HIV self-testing and implementation determinants among migrants: perspectives from West, East, Central, and Southern African migrants and key informants in the Netherlands

BACKGROUND: HIV self-testing (HIVST) has the potential to increase testing uptake among populations underserved by facility/clinic-based services, including African migrants in Europe. However, research on HIVST among African migrants in Europe and other high-income countries remains limited. OBJECTIVE: To explore perspectives on HIVST, identify barriers and facilitators to uptake, and provide recommendations to inform effective implementation among African migrants in the Netherlands. METHODS: Between February 2021 and May 2023, semi-structured interviews were conducted with 26 African migrants and 13 key informants, including healthcare providers (general practitioners, HIV specialists, testing service providers), policy and research professionals, and migrant community representatives. Data were analyzed using an inductive thematic approach. The Consolidated Framework for Implementation Research (CFIR) was applied post hoc to contextualize study findings within a broader implementation context. RESULTS: Participants' perspectives on HIVST centered on three themes: enhanced autonomy in decision-making and testing processes; navigating autonomy and support for self-testing and care linkage; and HIVST within the Dutch context and prevention landscape. Factors potentially influencing successful uptake and implementation were identified across multiple CFIR domains, including perceived relative advantage over facility/clinic-based testing, evidence on reliability, and procedural complexity (Innovation Characteristics); low self-efficacy, self-testing and linkage to care support needs (Individual Characteristics); HIV stigma, limited awareness and low visibility of HIVST (Outer Setting); and perceived incompatibility with existing healthcare systems (Inner Setting). CONCLUSIONS: Although HIVST can address key testing barriers among African migrants, targeted implementation strategies are needed to guarantee equitable access, proper use, and optimal outcomes. These include enhanced dissemination of HIVST information, normalization of HIV testing and self-testing, provision of person-centered support, and establishing clear pathways for timely care linkage when required.