Amrita Rao ^1* Henry Zodinliana Pachuau ² Samiran Panda ^3* Richard L Chawngthu ⁴ Rita Zomuanpuii ¹ Pranoti Hemade ¹ Amit Nirmalkar ¹

• ¹ National AIDS Research Institute (ICMR), Pune, Maharashtra, India
• ² Mizoram University, Aizawl, Mizoram, India
• ³ Indian Council of Medical Research (ICMR), New Delhi, India
• ⁴ Mizoram State AIDS Control Society, Aizawl, Mizoram, India

INTRODUCTION The ability of HIV self-test (HIVST) to connect individuals who might not otherwise access testing and anti-retroviral therapy (ART) formed the rationale of this investigation. The overall purpose was twofold: a) developing an HIV self-test implementation plan based on the findings of qualitative inquiry with the local stakeholders, and b) examining HIVST uptake among youths in the urban setting of Aizawl district, Mizoram. METHODOLOGY In the first phase, qualitative in-depth interviews (IDI) were conducted with HIV program officials, religious leaders, community influencers, youths, and key population groups. Such inquiries helped plan strategic communication, community engagement, HIVST delivery and linkages with HIV confirmatory test services in phase two. Factors associated with non-uptake of HIV confirmatory tests by youths following HIVST were analysed quantitatively. Secondary data on ‘Integrated Counselling and Testing Centre’ (ICTC) attendees was also analysed. RESULTS The in-depth interviews underscored the need to introduce HIV self-tests among Mizo-youths. The respondents viewed different outreach approaches and communication strategies, including the usage of social media platforms, as critical for HIVST implementation. They also shared insights on ‘where’ and ‘how’ to make HIVST kits available and accessible. Most of the youths taking HIVST were first-time testers (1,772/2,101; 84.3%). Those living with undiagnosed HIV infection were put on ART. Preference for blood-based HIVST format among youths (1162/2101; 55%) was slightly greater than the one using saliva. Confirmatory test seeking was significantly higher in those experiencing HIVST sero-reactive results (ꭓ2 23.89; p<0.001). Factors independently associated (adjusted odds ratio; AOR with 95% CI) with 'no-show for HIV confirmatory test' and thus having programmatic implications were 'age >20yr' (1.47; 1.18-1.82), 'male gender' (1.25; 1.01-1.55), 'education less than 10th standard' (5.16; 2.66-10.01), 'no prior HIV test experience' (2.12; 1.61-2.81), and 'unwillingness for HIV confirmatory test' (2.85; 2.05-3.96). Individuals opting for blood-based HIVST were 23% less likely (AOR 0.77; 95% CI; 0.62-0.96) to drop out of the HIV confirmatory test. Only 1% of respondents viewed HIVST to have self-harm potential. CONCLUSION Sustained community engagement, networking with HIV program officials, and strategic communication served as three critical pillars for HIVST implementation. HIVST uptake among young first-time testers was remarkable.