Perceptions, acceptability, and utilization of HIV self-testing kits among young people in urban slums in Kampala

Globally, 14% of people with HIV remain undiagnosed, delaying care and prevention. Youth in urban unplanned settlements face heightened risk due to poor access, stigma, and structural barriers, with HIV prevalence twice that of other urban areas. HIV self-testing (HIVST) offers a private, convenient approach to close this gap. We conducted a mixed-methods cross-sectional study among young people aged 15-24 living in Katanga Slum, Kampala, recruited by simple random sampling between February and May 2024. Quantitative data from 267 participants (mean age 20.1 years; 62.9% male) were analyzed using descriptive statistics and logistic regression, and qualitative data from focus group discussions were thematically analyzed. Acceptability of HIVST was high (87.6%) while utilization was lower (43.1%). Participants viewed self-testing positively, citing convenience, privacy, accuracy, stigma reduction, and clarity of instructions. Acceptability was associated with marital status, peer discussion, family support, and absence of financial barriers, while utilization was linked to religion and peer discussion. Qualitative findings highlighted privacy, affordability, availability, and trust in results as critical drivers of acceptability and use. Despite strong acceptance, uptake remains limited by cost and accessibility. Peer-led outreach, community engagement, and subsidized kits could enhance use and contribute to improved HIV prevention and early diagnosis in this high-risk population.