Self-testing for COVID-19 in Durban and Eastern Cape, South Africa: a qualitative inquiry targeting decision-takers

Innovative diagnostic solutions are essential to improve COVID-19 case detection and slow its spread in resource-constrained settings. To understand how South African communities may utilise rapid SARS-CoV-2 antigen self-testing and react to self-test results, we conducted a qualitative study, involving semi-structured interviews and focus group discussions, of healthcare workers, representatives of civil society groups, and potential self-testing implementors. A sex- and location-sensitive thematic analysis approach was used to assess how 52 decision-takers on self-testing roll-out in South Africa perceive the value and utility of this innovative diagnostic approach. Informants suggested South Africans might value a device that allows them to self-test in private, at their own convenience, while avoiding the risk of social stigma and having to wait for COVID-19 test results in a facility. They also emphasised the need for awareness and sensitisation campaigns and to ensure pre-/post-self-test counselling services are easily accessible. Collaboration with traditional leaders and community-based organisations would improve results communication and linkage to counselling and confirmatory testing. SARS-CoV-2 self-testing was perceived to be acceptable to a population already sensitised to the use of HIV self-testing, being a decentralised solution that would help reduce the incidence of COVID-19 and prevent any further deterioration of socio-economic indicators.