Evaluating a Social Network-Based Distribution Model for HIV Self-Testing Uptake Among Men Who Have Sex with Men in Dakar: A Mixed Methods Study

Men who have sex with men (MSM) in Senegal face significant barriers to conventional HIV testing services, including stigma and criminalisation. HIV self-testing (HIVST) offers a discreet alternative, but effective distribution models to reach this key population are required. This study evaluated the effect of a peer-led, social network-based distribution model on HIVST uptake among MSM in Dakar, Senegal. The primary objective was to measure the change in HIVST uptake. Secondary objectives explored the model’s acceptability and operational feasibility. A concurrent mixed methods design was employed. The quantitative component was a pre-post intervention analysis comparing HIVST uptake before and after the model’s implementation. The qualitative component involved in-depth interviews with a purposive sample of MSM participants and peer distributors to understand contextual factors influencing use and distribution. Quantitative results indicated a substantial increase in HIVST uptake, with the proportion of participants reporting ever using an HIVST kit rising from 12% pre-intervention to 67% post-intervention. Qualitative analysis identified three key themes: the critical importance of trust within networks for kit acceptance, the role of peer distributors in providing tacit emotional support, and persistent concerns about linkage to care following a positive result. A social network-based distribution model was highly effective in increasing HIVST uptake among MSM in Dakar. The model successfully leveraged existing trust relationships to overcome barriers to access. Programmes should integrate social network-based distribution of HIVST into existing services for MSM. Future interventions must concurrently strengthen confidential and non-stigmatising linkage to care pathways to ensure a comprehensive testing strategy. HIV self-testing, men who have sex with men, social networks, peer distribution, Senegal, key populations This study provides evidence for the effectiveness of a peer-led, network-based approach to HIVST distribution among MSM in a stigmatising legal context, highlighting both its potential for increasing testing uptake and the necessity of integrated care linkages.