Implementing a pilot study of COVID-19 self-testing in high-risk populations and remote locations: results and lessons learnt.

BACKGROUND: Rapid antigen-detection tests for SARS-CoV-2 self-testing represent a useful tool for pandemic control and expanding access to community-level case screening. COVID-19 self-tests have been extensively used in high-income countries since 2021; however, their introduction and programmatic implementation in low- and middle-income countries was delayed. We aimed to identify and continuously improve a weekly COVID-19 self-testing model among staff at healthcare facilities and schools. METHODS: This mixed-methods, observational prospective study was conducted in 5 healthcare centres and 24 schools in Georgia, between June and December 2022. The study comprised the integration of COVID-19 self-testing into the national mandatory testing programme for high-risk groups, with primary distribution of self-tests among staff performed weekly, plus secondary distribution to their household members. These use cases were selected because NCDC was seeking to strengthen their already strong weekly testing programme, by investigating self-testing to ease the burden of testing in the healthcare system. Online surveys and semi-structured interviews were used for data collection. RESULTS: In total, 2156 participants were enrolled (1963 female, 72%). At baseline and mid- and end-points, 88%, 97% and 99%, respectively, of participants agreed/strongly agreed they would self-test. Similarly, the majority were willing to report their self-testing results (88%, 98% and 96% at baseline and mid- and end-points, respectively). Weekly reporting of test results to the national COVID-19 database was high during all the implementation. There were 622 COVID-19 positive results reported, and linked to care, from 601 individuals (282 participants and 319 household members). Findings from qualitative interviews showed great satisfaction with self-testing for its convenience, ease of use, trust in the results, no need to travel for diagnostics, and increased perception of safety. CONCLUSIONS: Our findings contribute to the evidence-base regarding self-testing strategies conducted via workplaces and secondary distribution to households. Willingness to perform a COVID-19 self-test increased after implementation. This pilot enhanced pandemic preparedness through expansion of the national self-testing reporting system, development of communications materials, changes in the national legal framework and coordination mechanisms, and improved perceptions around self-care in the community. The lessons learnt can inform operational aspects of the introduction and scale-up of self-care strategies.

Values and preferences of the general population in Indonesia in relation to rapid COVID-19 antigen self-tests: A cross-sectional survey.

OBJECTIVES: Home diagnostics are essential to assist members of the general population become active agents of case detection. In Indonesia, a country with an over-burdened healthcare system, individuals could use rapid SARS-CoV-2 antigen tests to self-detect COVID-19. To assess the general population's values and attitudes towards SARS-CoV-2 self-testing, a survey was conducted in mid-2021 in Jakarta and the provinces of Banten and North Sulawesi. METHODS: This was a quantitative survey that approached respondents in >600 randomly selected street-points in the three study geographies in July-August 2021. A 35-item questionnaire was used to collect data on key variables, such as likelihood to use a SARS-CoV-2 self-test, willingness to pay for a self-test device, and likely actions following a positive self-test result. Bivariate and multivariate regression analyses were performed. RESULTS: Of 630 respondents (318 were female), 15.53% knew about COVID-19 self-testing, while 62.70% agreed with the idea of people being able to self-test at home, unassisted, for COVID-19. If self-tests were available in Indonesia, >60% of respondents would use them if they felt it necessary and would undertake regular self-testing for example weekly if recommended. Upon receiving a positive self-test result, most respondents would communicate it (86.03%), request post-test counselling (80.79%), self-isolate (97.46%), and/or warn their close contacts (90.48%). CONCLUSIONS: The use of rapid SARS-CoV-2 antigen detection tests for self-testing appears acceptable to a majority of the Indonesian public, to learn whether they have COVID-19. Self-testing should be prioritised to complement to an over-burdened healthcare system by helping the public, asymptomatic individuals included, become agents of change in epidemiological surveillance of SARS-CoV-2 in their communities.

Self-testing for SARS-CoV-2 in São Paulo, Brazil: results of a population-based values and attitudes survey.

BACKGROUND: Brazil is among the countries in South America where the COVID-19 pandemic has hit the general population hardest. Self-testing for SARS-CoV-2 infection is one of the community-based strategies that could help asymptomatic individuals at-risk of COVID-19, as well as those living in areas that are difficult for health personnel to reach, to know their infectious status and contribute to impeding further transmission of the virus. METHODS: A population-based survey was conducted in November 2021, to assess the acceptability of rapid SARS-CoV-2 antigen self-testing among the population of São Paulo. Survey respondents were approached at more than 400 different street-points that were randomly selected using a five-stage randomization process. A 35-item structured questionnaire was used. Dependent variables for our analyses were the likelihood to use and willingness to pay for self-testing, and the likelihood of taking preventive measures to prevent onward transmission of SARS-CoV-2 following a reactive self-test result. Bivariate and multivariate regression analyses were performed. RESULTS: Overall, 417 respondents (44.12% female) participated; 19.66% had previously had COVID-19 disease. A minority (9.59%) felt at high-risk of COVID-19. The majority of both females and males (73.91% and 60.09%, respectively) were in favor of the idea of SARS-CoV-2 self-testing. Overall, if self-tests were available, almost half of the sample would be very likely (n = 54, 12.95%) or likely (n = 151, 36.21%) to use one if they felt they needed to. Upon receiving a positive self-test result, the majority of respondents would communicate it (88.49%), request facility-based post-test counseling (98.32%), self-isolate (97.60%), and warn their close contacts (96.64%). CONCLUSION: Rapid SARS-CoV-2 antigen self-testing could be an acceptable screening tool in São Paulo. The population would be empowered by having access to a technology that would allow them to test, even if asymptomatic, when traveling, or going to work or school. If there is a surge in the incidence of cases, self-testing could be a good approach for mass case detection by Brazil's already overstretched Unified Health System.

Assessing Spaniard men's willingness and determinants to use a male contraceptive pill.

OBJECTIVE: As the clinical trials to develop male contraceptive pills are underway, understanding men's attitudes towards this contraceptive method is transcendental. This research was conducted to identify the degree of willingness and the determinants to use male contraceptive pill among Spaniard men. METHODS: A sample of 402 Spaniards men was presented with 36 scenarios comprising four within-subject factors (cost of pills, pill efficacy, side effects and context). In each scenario, a man is asked by his partner to use the contraceptive pill. Participants indicated their own willingness to use the pill in each circumstance. RESULTS: Cluster analysis revealed that participants took one of seven different positions regarding their willingness to use a contraceptive pill: never agree (10%); mainly depends on pill efficacy (6%); mainly depends on side effects (10%); depends on side effects and efficacy (12%); depends on context and side effects (12%); quite always (25%); always agree (25%). Participants' willingness to use contraceptive pills was more pronounced in the case of mild side effects and higher pill efficacy. CONCLUSION: Fifty percent of participants would use the male pill regardless of the circumstances. Access to this contraceptive method, when available, can contribute to greater equity in reproductive rights of the population.

Values and preferences for hepatitis C self-testing among people who inject drugs in Kyrgyzstan.

BACKGROUND: The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) continues to be a major public-health burden in this highly stigmatised population. To halt transmission of HCV, rapid HCV self-testing kits represent an innovative approach that could enable PWID to know their HCV status and seek treatment. As no HCV test has yet been licenced for self-administration, it is crucial to obtain knowledge around the factors that may deter or foster delivery of HCV self-testing among PWID in resource-constrained countries. METHODS: A qualitative study to assess values and preferences relating to HCV self-testing was conducted in mid-2020 among PWID in the Bishkek and Chui regions of Kyrgyzstan. Forty-seven PWID participated in 15 individual interviews, two group interviews (n = 12) and one participatory action-research session (n = 20). Responses were analysed using a thematic analysis approach with 4 predefined themes: awareness of HCV and current HCV testing experiences, and acceptability and service delivery preferences for HCV self-testing. Informants' insights were analysed using a thematic analysis approach. This research received local ethics approval. RESULTS: Awareness of HCV is low and currently PWID prefer community-based HCV testing due to stigma encountered in other healthcare settings. HCV self-testing would be accepted and appreciated by PWID. Acceptability may increase if HCV self-testing: was delivered in pharmacies or by harm reduction associations; was free of charge; was oral rather than blood-based; included instructions with images and clear information on the test's accuracy; and was distributed alongside pre- and post-testing counselling with linkage to confirmatory testing support. CONCLUSIONS: HCV self-testing could increase awareness of and more frequent testing for HCV infection among PWID in Kyrgyzstan. It is recommended that peer-driven associations are involved in the delivery of any HCV self-testing. Furthermore, efforts should be maximised to end discrimination against PWID at the healthcare institutions responsible for confirmatory HCV testing and treatment provision.

Values and preferences for hepatitis C self-testing among the general population and healthcare workers in Rwanda.

BACKGROUND: In 2018, Rwanda launched a 5-year hepatitis C virus (HCV) elimination plan as per the World Health Organization global targets to eliminate HCV by 2030. To improve awareness of HCV status, strategies are needed to ensure easy access to HCV testing by as-yet unreached populations. HCV-self-testing, an innovative strategy, could further increase HCV testing uptake. This assessment explores perceptions around HCV self-testing among members of the public and healthcare workers in Rwanda. METHODS: A qualitative study was undertaken in Masaka District Hospital, comprising individual interviews, group interviews and participatory action research (PAR) activities. Purposive and snowball sampling methods guided the selection of informants. Informed consent was obtained from all participants. A thematic analysis approach was used to analyse the findings. RESULTS: The participants comprised 36 members of the public and 36 healthcare workers. Informants appreciated HCV self-testing as an innovative means of increasing access to HCV testing, as well as an opportunity to test privately and subsequently autonomously decide whether to seek further HCV care. Informants further highlighted the need to make HCV self-testing services free of charge at the nearest health facility. Disadvantages identified included the lack of pre/post-test counselling, as well as the potential psychosocial harm which may result from the use of HCV self-testing. CONCLUSION: HCV self-testing is perceived to be an acceptable method to increase HCV testing in Rwanda. Further research is needed to assess the impact of HCV self-testing on HCV cascade of care outcomes.

Evaluation of a Training Program on Gender Mainstreaming in Health Research Evaluation at the Senegalese National Research Ethics Committee.

Health research must be of high ethical and scientific quality and consider the needs and experiences of women, men, and nonbinary individuals. National Research Ethics Committees (RECs) are in a strategic position to impede sex- and gender-blind research. In 2020 and 2021, training programs on gender mainstreaming and sex and gender approaches in research evaluation were launched in Senegal. They were evaluated through a mixture of qualitative and quantitative methods. Knowledge acquisition was 16.67%, 8.54%, and 28.42% for the trainees of 2021, 2020, and those who attended the training in both years, respectively. Gender mainstreaming was reported as pertinent in research ethics by 74% of participants. This training is expected to catalyze gender-transformative research ethics in West Africa.

User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania.

AIMS: Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC's attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices. METHODS: This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers. RESULTS: Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring. CONCLUSIONS: Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.

Gender differences in dentistry and oral sciences research productivity by researchers in Nigeria.

Background: The aim of the study was to assess gender differences in the productivity, impact, collaboration pattern and author position of dentistry and oral sciences researchers in Nigeria. Methods: We examined the Web of Science (WoS) publication records of dentistry and oral sciences researchers to assess gender differences in productivity, impact, collaboration and authorship pattern (first authorship, last authorship and corresponding author). The analysis included the number of publications in journals ranked based on their quartile rating amongst the journals in the subject area (Q1-Q4). Chi square was used to make gender comparisons. Significance was set at >5%. Results: 413 unique authors published 1,222 articles on dentistry and oral sciences between 2012 and 2021. The number of WoS documents per female author was significantly higher than that per male author (3.7 vs. 2.6, p = 0.03). A non-significantly higher percentage of females authored papers in Q2 and Q3 journals and a higher percentage of males authored papers in Q4 journals. The number of citations per female author (25.0 vs. 14.9, p = 0.04) and the percentage of females listed as first authors (26.6% vs. 20.5%, p = 0.048) were statistically greater than men. The percentage of males listed as last authors was statistically greater than females (23.6% vs. 17.7%, p = 0.04). The correlation between the percentage of papers with researchers listed as first authors and that listed as last authors was not significant for males (p = 0.06) but was significant for females (p = 0.002). A non-significantly greater percentage of females were listed as corresponding authors (26.4% vs. 20.6%) and males were listed as international (27.4% vs. 25.1%) and domestic collaborators (46.8% vs. 44.7%). Also, there was no statistically significant gender difference in the proportion of articles published in open access journals (52.5% vs. 52.0%). Conclusion: Though there were significant gender differences in the productivity, impact, and collaboration profile of dentistry and oral sciences researchers in Nigeria, the higher female research productivity and impact may be driven by cultural gender nuances that needs to be explored further.

Rapid SARS-CoV-2 Antigen Detection Self-Tests to Increase COVID-19 Case Detection in Peru: Qualitative Study.

BACKGROUND: The COVID-19 pandemic heavily impacted many low- and middle-income countries (LMICs), such as Peru, overwhelming their health systems. Rapid antigen detection self-tests for SARS-CoV-2, the virus that causes COVID-19, have been proposed as a portable, safe, affordable, and easy-to-perform approach to improve early detection and surveillance of SARS-CoV-2 in resource-constrained populations where there are gaps in access to health care. OBJECTIVE: This study aims to explore decision makers' values and attitudes around SARS-CoV-2 self-testing. METHODS: In 2021, we conducted a qualitative study in 2 areas of Peru (urban Lima and rural Valle del Mantaro). Purposive sampling was used to identify representatives of civil society groups (RSCs), health care workers (HCWs), and potential implementers (PIs) to act as informants whose voices would provide a proxy for the public's attitudes around self-testing. RESULTS: In total, 30 informants participated in individual, semistructured interviews (SSIs) and 29 informants participated in 5 focus group discussions (FGDs). Self-tests were considered to represent an approach to increase access to testing that both the rural and urban public in Peru would accept. Results showed that the public would prefer saliva-based self-tests and would prefer to access them in their community pharmacies. In addition, information about how to perform a self-test should be clear for each population subgroup in Peru. The tests should be of high quality and low cost. Health-informed communication strategies must also accompany any introduction of self-testing. CONCLUSIONS: In Peru, decision makers consider that the public would be willing to accept SARS-CoV-2 self-tests if they are accurate, safe to use, easily available, and affordable. Adequate information about the self-tests' features and instructions, as well as about postuse access to counseling and care, must be made available through the Ministry of Health in Peru.

Willingness to Use Male Contraceptive Pill: Spain-Mozambique Comparison.

Previous studies have suggested that social and cultural factors significantly influence people's willingness to use the male contraceptive pill, which is in relatively advanced development. The present study aims at comparing Spanish and Mozambican participants level of willingness to take a male contraceptive pill. Factorial designed scenarios were used to collect data on the two population samples (Spain = 402 participants; Mozambique = 412 participants). One-way analysis of variance (ANOVAs) were performed comparing the average scores of Mozambique and Spain at the levels of each modelled factor: The cost of the pills (30 €/USD 20 for 3 months vs. free); Efficacy (99% vs. 95%); Side effects (none, mild and severe); Context (disease, condom abandonment and diversification of contraceptive methods). The two groups found significant differences in the scores for each of the four factors, in light of the socio-cultural differences between the two countries. In the Spanish sample, the main factor affected the willingness to use male contraceptive pill (MCP) were the side effects, while for Mozambican men it was the context. Along with technological change, an ideological-social change in gender roles is required to ensure equity in contraceptive responsibilities and the participation of men at all socio-demographic levels in reproductive health.

A qualitative insight into researchers' perceptions of gender inequality in medical and dental research institutions in Nigeria.

OBJECTIVE: The aim of the study was to gain a qualitative insight into scientific researchers' perceptions of gender inequality inside Nigerian research institutions through an investigation of how gender equality is enacted in medical and dental research institutions in Nigeria. METHODS: This descriptive and cross-sectional qualitative study probed decision-making around navigating gender inequity and explored opinions about how a supportive environment for female medical and dental researchers could be established. Data were collected through semi-structured telephone interviews with 54 scientific researchers across 17 medical and dental academic institutions in Nigeria between March and July 2022. Data were transcribed verbatim and analyzed using thematic analysis. RESULTS: Three core themes emerged: institutionalized male dominance in research institutions; changing narratives on gender equalities in research and academic enterprise; and women driving the conscience for change in research institutions. Female medical and dental researchers' perceived gender equality was challenging mainstream androcentric values in knowledge production within the medical and dental field; and queries the entrenchment of patriarchal values that promote a low number of female medical and dental trainees, fewer female research outputs, and few women in senior/managerial positions in the medical fields. CONCLUSION: Despite the general view that change is occurring, a great deal remains to be done to facilitate the creation of a supportive environment for female medical and dental researchers in Nigeria.

COVID-19 self-testing in Nigeria: Stakeholders' opinions and perspectives on its value for case detection.

BACKGROUND: COVID-19 testing coverage is limited in Nigeria. Access to rapid SARS-CoV-2 antigen-detection self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the country's low rate of SARS-CoV-2 testing. Before implementing self-testing in Nigeria, assessing the population's perceptions regarding this approach is imperative. In mid-2021, an exploratory cross-sectional qualitative research was conducted to investigate stakeholders' values and preferences for SARS-CoV-2 self-testing in Nigeria. METHODS: In-person and online semi-structured interviews and focus group discussions with healthcare workers, representatives of civil society, and potential implementors of self-testing delivery programs were used to explore values and perceptions around access to conventional provider-initiated COVID-19 testing. Topics included the public's values in relation to SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, and likely actions upon receiving a positive SARS-CoV-2 self-test result. A thematic analysis approach was applied. RESULTS: The 58 informants (29 female) reported that Nigeria has limited availability of conventional provider-delivered SARS-CoV-2 testing. While just a few informants were familiar with SARS-CoV-2 self-testing, they generally supported using self-testing as an approach that they felt could assist with early case detection and improve access to testing. Concerns relating to the use of self-testing mainly related to the ability of low-literate individuals to use and interpret the self-tests, the affordability of self-tests, equity of access, and the availability of healthcare system support for those who self-test positive. CONCLUSION: Although the Nigerian public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the perceived inefficiency of the national health service delivery system may limit the access of users of the kits to psychosocial and clinical support. Nevertheless, in Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.

People's willingness to use COVID-19 self-testing in Nigeria: a cross-sectional survey.

OBJECTIVES: Nigeria has been badly affected by the COVID-19 pandemic, and the poor testing coverage in the country may make controlling the spread of COVID-19 challenging. The aim of this study was to assess the general public's acceptability of SARS-CoV-2 self-testing as an approach which could help to address this gap. SETTING: A household-based survey was conducted in five urban and five rural local government areas in the states of Akwa Ibom, Anambra, Benue, Kaduna and Lagos, in mid-2021. PARTICIPANTS: 2126 respondents (969 were female) participated. A five-pronged, probabilistic sampling approach was used to recruit individuals older than 17 years and available to participate when randomly approached in their households by the surveyors. A 35-item questionnaire was used to collect data on their values towards SARS-CoV-2 self-testing. Primary outcomes were: likelihood to use a self-test; willingness to pay for a self-test; and likely actions following a reactive self-test result. RESULTS: Of the total 2126 respondents, 14 (0.66%) were aware of COVID-19 self-testing, 1738 (81.80%) agreed with the idea of people being able to self-test for COVID-19, 1786 (84.05%) were likely/very likely to use self-tests if available, 1931 (90.87%) would report a positive result and 1875 (88.28%) would isolate if they self-tested positive. Factors significantly associated with the use of a self-test were having a college education or higher (adjusted Odds Ratio (AOR): 1.55; 95% CI: 1.03 to 2.33), full-time employment (AOR: 1.67; 95% CI: 1.06 to 2.63), feeling at moderate/high risk of COVID-19 (AOR: 2.43; 95% CI: 1.70 to 3.47) and presence of individuals at risk of COVID-19 within the household (AOR: 1.38; 95% CI: 1.06 to 1.78). CONCLUSION: A majority of Nigerians agree with the concept of COVID-19 self-testing and would act to protect public health on self-testing positive. Self-test implementation research is necessary to frame how acceptability impacts uptake of preventive behaviours following a positive and a negative self-test result.

Values of COVID-19 Self-Testing among Urban and Rural South Africans: A Cross-Sectional Survey.

Self-testing for COVID-19 may be a preferable strategy for identifying SARS-CoV-2 infection among populations in low- and middle-income settings. To determine South Africans' values related to COVID-19 self-testing should it become widely available, a cross-sectional survey was administered in Durban, KwaZulu-Natal Province and the King Sabata Dalindyebo sub-district of the Eastern Cape. A 35-question survey was administered to 531 participants (268 female) in one urban and one rural setting of South Africa. Survey participants were randomly selected by household in the rural setting, while in the urban setting participants were approached in randomly selected public places. The survey assessed participants' likelihood of using and willingness to pay for a COVID-19 self-test and actions they would take following a COVID-19 self-test. The results were analysed using descriptive statistics and bivariate and multivariate regression. Overall, 93.03% of participants supported COVID-19 self-testing, 61.62% of participants were willing to pay for self-testing, and 90.15% indicated they would communicate their results if they tested positive. Rural participants were more positively associated with each of these outcomes compared with urban-based participants. Should they test positive, most participants said they would: go in-person to a health facility for counselling (76.45%), self-isolate (95.85%), notify close contacts (97.74%), and inform their employer (95.14%). COVID-19 self-testing was a preferable option for most participants, although this varied with setting and demographic characteristics. Self-testing may overcome barriers to care for South Africans, but to achieve this, policies for self-testing and delivery methods must not exacerbate individuals' underlying economic vulnerabilities.

SARS-CoV-2 self-testing in Peru: a cross-sectional survey of values and attitudes of the general population.

OBJECTIVES: To assess the values of and attitudes towards the use of rapid SARS-CoV-2 antigen-detection tests for self-testing in a rural and an urban area in Peru. DESIGN: Cross-sectional, street-based population survey. SETTING: A series of over 400 randomly selected street points in Valle del Mantaro and in Lima. PARTICIPANTS: 438 respondents (203 female) participated. They were all older than 17 years and provided informed consent for participation. INTERVENTION: All respondents answered on the spot, a 35-item questionnaire developed in KoboToolbox. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes of interest were: likelihood to use a SARS-CoV-2 self-test; willingness to pay for a SARS-CoV-2 self-test and likelihood to comply with recommended actions following a positive SARS-CoV-2 self-test result. Bivariate analyses and Poisson regression (PR) analyses were performed to identify significant associations between dependent variables and independent variables pertaining to respondents' characteristics, risk perception and previous experiences with conventional COVID-19 testing. RESULTS: Of the 438 respondents, 51.49% had previous experience with conventional COVID-19 testing; 20.37% had COVID-19 disease; 86.96% accepted the idea of SARS-CoV-2 self-testing; and, 78.95% would be likely to use it if needed. Almost all (94.75%) would pay for a self-testing device (mean acceptable payment: US$10.4) if it was not provided free of charge by health authorities. Overall, 93.12%, 86.93% and 85.32% would self-isolate, report the results and warn their contacts, respectively. Being a female (adjusted PR 1.05, 95% CI 1.00 to 1.09, p<0.018), having completed secondary education (adjusted PR 1.18, 95% CI 1.02 to 1.37, p<0.024) and expressing likelihood to use self-testing (adjusted PR 1.08, 95% CI 1.01 to 1.16, p<0.0.24) could be predictors of willingness to pay for a self-test. CONCLUSIONS: Self-testing is perceived as an acceptable approach. Health authorities in Peru should facilitate access to this approach to complement healthcare facilities-led testing efforts for COVID-19. Future research is necessary to understand the impact of self-testing in case detection and pandemic control.

COVID-19 self-testing, a way to "live side by side with the coronavirus": Results from a qualitative study in Indonesia.

Alongside mass vaccination for COVID-19, sustainable diagnostic strategies for SARS-CoV-2 are needed to empower local communities and help them complement health authorities' efforts to end the pandemic in low- and middle-income countries. Indonesia is among the nations with an overstretched health system that may benefit from technological innovations, such as rapid SARS-CoV-2 antigen-detection tests for self-testing, to detect asymptomatic cases and interrupt the transmission of the virus to healthy individuals. In mid-2021, we conducted a qualitative research study with the aim of understanding key decision-makers' values and preferences regarding the implementation of COVID-19 self-testing in Indonesia. This research received ethics approval from the Universitas Katolik Indonesia Atma Jaya and used a thematic analysis approach to explore the insights expressed by healthcare workers, representatives of civil society, and potential self-testing implementers in three geographies: Jakarta, Banten, and North Sulawesi. Thirty semi-structured interviews and six focus group discussions were carried out. As per the informants' narratives, the Indonesian public might accept rapid SARS-CoV-2 antigen-detection self-testing as a tool that will enable them to test for COVID-19 at their own convenience. Concerns were expressed that the public might doubt the reliability of self-testing kits if these were not properly regulated and if counterfeit kits were known to be on the market. Fear of stigma, isolation, and clinical care costs were perceived to be among the drivers for self-test users to not report a reactive result. These fears might be mitigated, as per the informants' opinions, by awareness raising, passing of regulations, and participatory engagement of a range of community actors, such as village officers. Decision-makers consider rapid SARS-CoV-2 antigen-detection self-testing to be a welcomed screening tool that could contribute to ensuring earlier access to treatment and decrease transmission of SARS-CoV-2 in Indonesia.

Management of Female Genital Mutilation/Cutting-Related Obstetric Complications: A Training Evaluation.

Although female genital mutilation/cutting (FGM/C) is a prevalent practice in Liberia, healthcare workers lack the capacity to provide adequate care for FGM/C survivors. Therefore, Liberian nurses, physician assistants, midwives and trained traditional midwives were trained in sexual, obstetric and psychosocial care for FGM/C survivors in 2019. Through questionnaires, we assessed knowledge acquisition, trainee attitudes towards FGM/C care and acceptability to implement WHO-endorsed recommendations. The questionnaires were analyzed using descriptive statistics for quantitative data and an inductive approach for qualitative data. A total of 99 female and 34 male trainees participated. Most trainees perceived FGM/C as harmful to women's health, as a violation of women's rights and showed a willingness to change their clinical practice. While 82.8% (n = 74/90) perceived their role in advocating against FGM/C, 10.0% (n = 9/90) felt that they should train traditional circumcisers to practice FGM/C safely. The pre-training FGM/C knowledge test demonstrated higher scores among physician assistants (13.86 ± 3.02 points) than among nurses (12.11 ± 3.12 points) and midwives (11.75 ± 2.27 points). After the training, the mean test score increased by 1.69 points, from 12.18 (±2.91) points to 13.87 (±2.65) points. The trainings successfully increased theoretical knowledge of FGM/C-caused health effects and healthcare workers' demonstrated willingness to implement evidence-based guidelines when providing care to FMG/C survivors.

A global grounded theory exploration of investigators' perspectives on male hormonal contraceptive development and acceptability.

While best practices have been proposed on how to engage men in family planning (FP), the limited options of male hormonal contraceptives (MHC) are a barrier to reaching men as clients of FP programs. The lack of alternative MHC is preventing the global health community from providing holistic reproductive healthcare. A qualitative grounded theory study was conducted in 2020 to explore MHC experts' perceptions around the development and theoretical acceptability of MHCs. Individual in-depth interviews were conducted with 15 key informants. The informants cited evidence that there is a demand for MHC. The inability to access this data by the pharmaceutical industry was acknowledged. Many informants expressed concern of the possibility for MHC to increase male power in a predominantly patriarchal world. To most informants, at least for the initial introduction of MHC, fertility sharing is something that will largely happen among couples alone rather than individually. There is proven demand among women and men for MHC, however industries may still be reluctant to invest. Effort is needed by the sexual and reproductive health and rights community to include male engagement in FP and to advocate for the development and use of MHC as a tool for women's empowerment.

Acceptability of a Smartphone Application to Enhance Healthcare to Female Genital Mutilation Survivors in Liberia: A Qualitative Study.

In Liberia, female genital mutilation/cutting (FGM/C) is a legally allowed initiation ritual in the secret Sande society. Due to the secrecy, Liberian healthcare providers receive little education on FGM/C and its health consequences. As mobile learning approaches proved to efficiently increase providers' knowledge and skills, a mobile application ('app') was designed to support self-learning, decision-making, and the follow-up of FGM/C survivors' health. The 'app' was introduced in a capacity-building project in 2019 and evaluated through this qualitative study to assess healthcare provider's needs and acceptance. We conducted 22 semi-structured interviews and eight focus group discussions with 42 adult healthcare providers in three Liberian counties. A thematic approach grounded in descriptive phenomenology guided data analysis and led to three main themes: the 'app', mobile learning and health education, and personal impression. Healthcare providers judge the 'app' useful to broaden their knowledge and skills, which might lead to better FGM/C detection and management. The 'app' might further facilitate patient and community education about the negative health consequences of FMG/C, possibly contributing to a reduction of FGM/C prevalence.