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Abstract Background HIV self-testing (HIVST) provides young people with a convenient, discreet, and empowering way to know their HIV status. However, there is limited knowledge of young people’s preferences for HIVST services and potential factors that may influence the uptake of HIVST among this population. The purpose of this research was to use qualitative methods to examine HIVST preferences among Nigerian youth. Methods Semi-structured in-depth interviews with a purposive sample of young people 14–24 years old were conducted in Lagos, Nigeria. Data were analyzed thematically to identify themes and domains related to preferences and factors influencing the use of HIV self-testing. Results A total of 65 youth with mean age of 21 years, were interviewed, and the majority were females (56%). Four themes emerged as the most important characteristics that may influence young people’s preferences for HIV self-testing: 1) Cost (i.e. majority of participants noted that they would pay between NGN500 to NGN1,500 naira (USD1.38–USD4.16) for oral HIV self-testing kits); 2) Testing method (i.e. although blood-based sample kits were more popular than oral-based self-testing kits, most preferred the oral-based option due to its perceived benefits and for some, phobia of needles); 3) Access location (i.e. participants suggested they preferred to obtain the HIVST kits from youth-friendly centers, pharmacies, private health facilities, and online stores); and 4) Continuing care and support (i.e. participants highlighted the importance of linkage to care with trained youth health workers for positive or negative test results or toll-free helpline). Conclusion HIV self-testing preferences among Nigerian youth appear to be influenced by several factors including lower cost, less invasive testing method, location of testing, and linkage to care and support post testing. Findings underscore the need to address young people’s HIV self-testing preferences as a foundation for implementing programs and research to increase the uptake of HIVST.

Background: Providing a platform to engage young people as active participants and decision-makers in the design and delivery process of HIV testing efforts is critical to optimise uptake of HIV testing and other preventive services among this population. Designathon, an intensive team-based contest to crowdsource solutions, is a form of participatory approach that may increase the effectiveness of implementation strategies by fully engaging the end users in the design process. In this study, we explore strategies for HIV self-testing (HIVST) delivery developed at a designathon contest in Nigeria. Methods: The 48-h HIVST designathon held from March 29 to March 31, 2019, in Lagos state, Nigeria, occurred in three phases. First, we solicited solutions from Nigerian youth on how to encourage self-testing for HIV and other sexually transmitted infections in a way that is low-cost, accessible, youth-friendly and confidential. Second, submissions were shortlisted by an advisory committee and the top teams were invited to compete at the designathon contest. Third, the top teams presented their strategies using the business model canvas (BMC) to an expert panel. The BMC included: (1) description of the value of the HIVST service; (2) how and where to deliver HIVST; and (3) youth-friendly HIVST service strategies. Thematic analysis was used to explore key elements of the business model canvas. Findings: Of the 127 submissions received, 13 teams (with a total of 42 participants) were selected to participate at the designathon. Participants' median age was 22·5 years (IQR 21–24 years) and 28 (67%) were male. Teams developed segment-specific approaches such as online (ie, unstructured supplementary service data (USSD) services, gamification) and offline (ie, vending machines, community youth mobilisers) options for distributing and promoting the HIVST kit to reach a wider range of young people in both urban and rural settings. Multi-stakeholder partnerships at the local, state, and federal level were identified as key implementation mechanisms to drive scale-up and sustainability efforts. Interpretation: Designathons are a feasible method of facilitating meaningful youth engagement to develop deployable strategies to increase the uptake of HIV testing in young people in Nigeria. Additional refinement and rigorous evaluations of the proposed strategies in practice is an important next step to assess the effectiveness and impact of the models. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant number: 1UG3HD096929 and NIAID K24AI143471

Background: There is a critical gap in the uptake of HIV testing among young people in sub-Saharan Africa. In Nigeria, only a quarter of young people aged 14–24 years have ever tested for HIV. Recent evidence suggests that HIV self-testing (HIVST) may play a role in addressing gaps in HIV testing coverage and serve as an entry point for HIV prevention services. However, there is limited information on strategies that may increase the uptake of HIV testing among young people. Current strategies rarely include young people in the design stages, which often results to poor adoption of HIV interventions. We aimed to address this gap with the development of an innovation bootcamp for participants aged 14–24 years to generate interventions to promote HIVST among young people in Nigeria. Methods: The innovation bootcamp was a 4-week accelerated training programme to build entrepreneurial and research capacities among young people to develop HIV self-testing social enterprise. The training programme consisted of social enterprise and research development modules. At the completion of the bootcamp, we also examined participants' perspectives of the programme using surveys. Findings: Between May 6 and May 30, 2019, 20 people participated in the innovation bootcamp in Lagos State, Nigeria; 13 (65%) were male and age range was 22–24 years. The innovation bootcamp generated five youth-participatory HIVST social enterprises. Two of the social enterprise focused on repacking HIVST kits to increase their appeal among young people, one idea focused on leveraging community engagement platforms (vocational skills training and youth community events) to promote HIVST, and another social enterprise seeks to use a reward-referral system to promote HIVST in young people. Participants' survey responses suggest that the innovation bootcamp fostered an environment for young people to connect with their peers to generate ideas and solutions. The bootcamp also provided opportunities for skills development such as logistics management and research (protocol writing, data collection, and needs assessment) skills. Interpretation: The innovation bootcamp model can leverage the resourcefulness, capabilities, and resilience of youth to generate youth-centred and youth-sensitive interventions to promote HIV testing. The innovation bootcamp led to the development of five youth-centred and participatory interventions to promote uptake of HIV self-testing among young people in Nigeria. Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant number: 1UG3HD096929 and NIAID K24AI143471