Perceived barriers and facilitators to the feasibility and acceptability of a peer-to-peer (P2P) HIV self-testing distribution model among adolescents and young people aged 15–24 years in Uganda: a qualitative study
Denis Ndekezi, Richard Muhumuza, Jackline Namara, Rehema Nagawa, Esther Awino, Felix Rutaro, Joanita Nassali, Andrew Sentoogo SsemataIntroduction
Peer-to-peer HIV self-testing (HIVST) has shown promise in addressing barriers to HIV testing challenges by leveraging social networks and peer influence to promote health-seeking behaviours.
Objective
To explore the perceived feasibility and acceptability of the peer-to-peer HIVST distribution model among adolescents and young people aged 15–24 years in Uganda.
Methods
We conducted a descriptive exploratory qualitative study in Wakiso District, Uganda. Data were collected through six focus group discussions (n=68) and 14 in-depth interviews, including interviews with peer leaders. Participants were purposively recruited through community meetings with support from Village Health Teams. Discussions explored perceptions of peer-to-peer HIVST distribution, including potential barriers and facilitators. Interviews were audio-recorded, transcribed verbatim, translated into English and analysed using thematic analysis.
Results
Participants perceived the peer-to-peer HIVST distribution model as both feasible and acceptable. Key facilitators of feasibility included peer trust, structured training, community-based delivery and integration with existing health structures. Perceived barriers included logistical constraints, inadequate supervision, kit storage challenges and concerns about equitable reach. Acceptability was driven by trust, confidentiality, emotional support, autonomy and the relatability of peer distributors. However, concerns about gossip, stigma, confidentiality breaches and the emotional burden placed on peer distributors were identified as potential barriers to sustained acceptability.
Conclusion
Peer-to-peer HIVST distribution was perceived as a feasible and acceptable approach for increasing HIV testing among adolescents and young people. Future implementation efforts should strengthen peer training and supervision, address confidentiality and stigma concerns, provide psychosocial support for peer distributors, and ensure equitable access for socially marginalised adolescents.