How did people in three African countries view rapid self-testing, with or without an app?

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Rapid diagnostic test (RDT) self-testing integrated with mobile phone apps could improve health outcomes in low-resource settings, including sub-Saharan Africa. Uptake remains limited, however, partly because of concerns about accuracy, accessibility, and integration into existing health care systems.

The study assessed the acceptability of self-testing for various health conditions, both independently and with app assistance, among community members, health care providers (HCPs), and community and public health leaders in Kenya, South Africa, and Zambia. Researchers conducted an exploratory qualitative study in rural and urban areas of the three countries from May 15 to August 24, 2023. They used key informant interviews with community leaders and public health leaders in health ministries or departments, in-depth interviews (IDIs) with HCPs, and IDIs and focus group discussions (FGDs) with community members. Using framework analysis guided by the Theoretical Framework of Acceptability, they assessed affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy toward RDT self-testing with and without app assistance across countries and participant types. The 178 participants included 24 key informants, 41 HCPs, and 113 community members, with 55 IDIs and 11 FGDs conducted across the three countries.

Standalone and app-assisted self-testing were highly acceptable to community members, HCPs, and community and public health leaders in all three countries, who valued their potential to empower individuals, improve health care access, and make delivery more efficient. Self-testing aligned with values of privacy, confidentiality, and autonomy and was seen as extending reach to underresourced areas. Participants valued its potential to save time, reduce opportunity costs, facilitate early diagnosis and treatment, and ease burdens on health care systems. They perceived the benefits as outweighing possible risks, including human error, false readings, and emotional distress from unexpected results, especially when an app could provide real-time guidance and improved health care coordination. Apps were praised for modernity, convenience, and their ability to streamline processes for users and health care systems. Foreseeable challenges included resistance among less tech-savvy people, ethical concerns such as misuse of self-tests, technological barriers, data security, training needs, and insufficient digital and physical infrastructure for equitable implementation. Regular education, system support, integration, and community trust were identified as critical for success.

The researchers concluded that self-testing, alone or app-assisted, was viewed as acceptable and relevant to improving health care accessibility and efficiency in these low-resource settings. They said optimizing its benefits requires addressing test accuracy, infrastructure development, data privacy, and integration into existing health care systems. They also called for policies emphasizing education, support, user-friendly design, and minimal costs to support equitable access and effective implementation across diverse populations.