Background: To understand the private sector''s ability to reach adolescents and young people with high quality HIV self-testing (HIVST) services, we conducted a mystery shopper study at pharmacies and private health facilities participating in an HIVST demonstration project in Nairobi and Mombasa.
Methods: Outlets were randomly selected for the study. Facility owners provided verbal consent, but were not informed about the date or time of visits. Mystery shoppers ages 18-30 visited facilities and attempted to purchase a quality-assured HIVST kit using one of 14 pre-defined mystery shopper scenarios. Scenarios included instructions for the shopper''s age (range: 16-24 years), reason for testing, and type of kit to be purchased, and questions to ask the provider. After the visit, shoppers were interviewed about their experiences using a structured guide administered by a trained surveyor.
Results: In Sep. 2018, 28 mystery shoppers visited 14 private health facilities and 41 pharmacies. While the project set the consumer price for both HIVST kits at 500Ksh, 6 (11%) facilities sold them at higher prices. Observed prices ranged from 150Ksh-900Ksh. Most facilities (25, 45%) stored kits in a storage room accessible only to employees, or under/behind the counter (10, 18%). Complete stock-outs weren´t uncommon (7/55 facilities), and a further 5 facilities had just a single brand of quality-assured HIVST in stock at the time of the visit. While 42/55 providers gave clients information to help them use the test kit, and 36 provided a step-by-step explanation on using the kit, slightly fewer (27, 49%) could answer specific test-use questions satisfactorily. Misinformation, unfriendliness, lack of privacy, and provider preferences for one test kit over the other were also reported.
Conclusions: Despite a one-time training and monthly medical detailing visits, HIVST service delivery quality was uneven. Kit prices ranged substantially, as did the ability/willingness of providers to answer questions or demonstrate the use of the kits. Because kits were not stocked on shelves, providers acted as an important mediator for consumers deciding on which test kit to purchase. Further supportive supervision efforts may be needed to ensure providers are able to support consumers in safely using and interpreting the results of HIVST kits.