Abstract
BACKGROUND: Despite progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, Zambia faces persistent gaps in HIV testing coverage. The Ministry of Health implemented blood-based HIV self-testing (HIVST) to improve accessibility. This study evaluated the CheckNOW™ HIVST kit's usability in Lusaka province health facilities. OBJECTIVE: To determine usability, awareness and user-friendliness of the CheckNOW™ HIVST among Zambian adults. METHODS: We conducted a cross-sectional study from 04 September 2023 - 22 September 2023 across four high-volume healthcare facilities. A total of 323 CheckNOW™ HIVST kits were distributed, with 316 consenting adults successfully enrolled in the study. Data were collected through structured questionnaires administered via face-to-face interviews following test completion, capturing information on socio-demographics, HIV testing history and user perception of the self-testing process. Descriptive statistics were employed for data analysis. RESULTS: Among 316 participants, 56.3% (178/316) were female, and 41.5% (131/316) were aged 25-34 years. The majority (95.0%, 300/316; p < 0.001) found the CheckNOW™ kit easy to use, while 65.0% (206/316) had prior awareness of HIVST. Additionally, 83.6% (264/316; p < 0.001) followed the test instructions correctly and independently. A high proportion (98.7%, 312/316; p < 0.001) expressed willingness to test again, and 99.7% (315/316; p < 0.001) would recommend it to others. CONCLUSION: The CheckNOW™ blood-based HIVST kit demonstrated high usability and ease of use, supporting its potential to expand HIV testing coverage in Zambia. However, increased awareness efforts are necessary to maximise uptake and ensure broader accessibility. WHAT THIS STUDY ADDS: This study provides the first evidence that blood-based HIV self-testing is feasible and acceptable within Zambian clinical settings. It offers a critical new strategy to expand testing coverage and reach key populations by integrating self-testing into routine health services.