The study was conducted to determine HIV testing preferences, uptake of HIVST and its associated factors among young adults in a public university. Overall, 55% of the young adults had tested by themselves at home which was congruent with their preferences to use HIV self-testing in the future. HIV self-testing was preferred over provider-based HIV testing because of the associated privacy and convenience linked to HIVST. These study findings should be interpreted in light of its limitations. Although we maintained anonymity in data collection, social desirability bias is likely given the sensitivity of the topic under study.

Nevertheless, because we measured for both the preferences and actual behaviours in HIV self-testing, the study findings are likely to be valid. The study provides important implications that can promote adoption of HIV testing approaches that can improve HIV testing among young adults. Ultimately, the improved HIV testing can contribute to the attainment of the sustainable development goals to reduce the AIDS epidemic by 2030 [3].

In our study, the uptake of HIV self-testing was 55% which was consistent with 56% of participants who preferred to use HIV self-testing over provider-based in the future among young adults. This highlights a congruence between preferences for HIV self-testing among young adults and their actual behaviours. The HIV self-testing in our study was higher than 24% reported among university students in Central Uganda [11]. The high uptake of HIV self-testing in our study may be attributable to the study population who were medical and nursing students, and thus, had some level of knowledge regarding HIV testing.

The majority of young adults preferred HIV self-testing which was consistent with high preferences and acceptability for HIVST in most of the studies [11,13,14]. Qualitative studies have equally reported that young adults find HIVST services to be more preferable, acceptable, feasible and appropriate [10,12]. Contrary to our study findings, 77% of adolescents and young girls in Kenya preferred provider-aided HIV testing to HIVST probably related to low levels of literacy [15]. This highlights that one size may not fit all, and that it is critical to consider the socio-demographic profile of young adults especially their levels of literacy in promoting HIVST practices.

One of the major findings in our study was that young adults valued privacy and confidentiality associated with HIV self-testing. Previous studies have equally reported that young adults prefer HIV self-testing because of its privacy and confidentiality [10,16]. HIVST eliminates youth-related barriers that affect uptake of HIV testing services among young adults [10,12]. Young adults face numerous barriers such as provider bias, discrimination, stigma, and negative judgement from older clients in the clinic-based HIV testing all of which were not of much concern in HIVST [10]. Adolescents and young adults are able to test themselves for HIV in the privacy of their homes without judgment, discrimination or mistreatment in the health facilities [10]. The resulting confidentiality of the test results enables young adults to maintain their dignity and autonomy while accessing HIV testing services [10,13].

Previous studies have underscored that young adult find HIVST to be more convenient, easy to use, efficient, and that it saves time and money [16-18]. This was consistent with our study findings where young adults preferred HIVST and the majority of them used HIVST because it was more convenient for them. The convenience in HIV self-testing can enable couples to test before sex and promote safer sex practices, while it is also known to increase HIV testing across all populations including young adults [9]. The convenient self-testing can assuage the lack of youth-friendly health services which deters the majority of young adults from going to health facilities for HIV testing [10]. Furthermore, convenience in self-testing for HIV eliminates health system bottlenecks especially in a setting like Uganda where long waiting times, distant health facilities, lack of HIV testing services, and shortage of personnel can deter many young adults from testing for HIV [17].

Young adults in our study who preferred provider-based HIV testing over HIVST did so because testing in the health facilities were seen to provide more accurate, trustworthy, credible, and reliable test results. Although the accuracy of test results in HIVST is equivalent to that from health facility-based HIV testing [15,19], previous studies have underscored young adults’ scepticism over the accuracy of test results obtained from HIVST [18,20]. Concerns over accuracy in HIVST were even more pronounced in oral-based HIV test kits than in blood-based HIV test kits [21]. Therefore, it is important to address fears and scepticism regarding accuracy of results from HIVST as concerns over test accuracy may act as a deterrent for use of HIVST among young adults [17].

Previous studies have highlighted the lack of pre-test and post-test counselling in HIV testing as a major concern for individuals seeking HIV testing [14,17]. Our study findings were consistent with studies which cited lack of counselling as a major deterrent for uptake of HIVST [10,20]. The lack of counselling in HIVST has been suggested to result in gender-based violence, emotional distress, suicide and self-harm though evidence to that effect is currently lacking [14,18,20]. This may be because individuals who opt for HIV self-testing are informed that HIVST does not confirm the HIV status but that it serves to screen for HIV [9]. HIVST approaches that include virtual counselling by healthcare providers through the mobile telephone have been suggested to meet the needs of young adults to access counselling before and after the HIV test [21]. Post-test counselling over the telephone can reduce maladaptive behaviours in case of the positive test [21].

The predictors for uptake of HIVST in our study were consistent with those in the literature [11,20,22]. Participants with multiple sex partners were more likely to have used HIVST, a finding which was similar to that in Tanzania [20]. The increased odds of HIVST among participants with multiple sex partners was plausible because the new partners may have to be tested at the point of sexual encounter. Our study was consistent with a study in Nigeria where young adults were less likely to have HIVST as they get older [22]. The increased likelihood of HIVST among younger people is likely because of higher sexual activity among younger people than their older counterparts. Similar to our study findings, previous studies have reported socio-demographic variables such as religion, program of study, and year of study to be associated with HIVST [11,20].