BACKGROUND:
Increased
uptake of HIV testing by men in sub-Saharan Africa is essential for the success
of combination prevention. Self-testing is an emerging approach with high
acceptability, but little evidence exists on the best strategies for test
distribution. We assessed an approach of providing multiple self-tests to women
at high risk of HIV acquisition to promote partner HIV testing and to
facilitate safer sexual decision making.
METHODS:
In this
cohort study, HIV-negative women aged 18-39 years were recruited at two sites
in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and
a drop-in centre for female sex workers. Participants gave informed consent and
were instructed on use of oral fluid based rapid HIV tests. Participants
enrolled at the health facility received three self-tests and those at the
drop-in centre received five self-tests. Structured interviews were conducted
with participants at enrolment and over 3 months to determine how self-tests
were used. Outcomes included the number of self-tests distributed by
participants, the proportion of participants whose sexual partners used a
self-test, couples testing, and sexual behaviour after self-testing.
FINDINGS:
Between
Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in
antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up
interviews were completed for 265 (96%). Most participants with primary sexual
partners distributed self-tests to partners: 53 (91%) of 58 participants in
antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female
sex workers. 82 (81%) of 101 female sex workers distributed more than one
self-test to commercial sex clients. Among self-tests distributed to and used
by primary sexual partners of participants, couples testing occurred in 27
(51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53
(83%) of 64 female sex workers. Among tests received by primary and non-primary
sexual partners, two (4%) of 53 tests from participants in antenatal care, two
(2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had
positive results. Participants reported sexual intercourse with 235 (62%) of
380 sexual partners who tested HIV-negative, compared with eight (18%) of 45
who tested HIV-positive (p<0·0001); condoms were used in all eight
intercourse events after positive results compared with 104 (44%) after of
negative results (p<0·0018). Four participants reported intimate partner
violence as a result of self-test distribution: two in the post-partum care
group and two female sex workers. No other adverse events were reported.
INTERPRETATION:
Provision
of multiple HIV self-tests to women at high risk of HIV infection was
successful in promoting HIV testing among their sexual partners and in
facilitating safer sexual decisions. This novel strategy warrants further
consideration as countries develop self-testing policies and programmes.
1Department of Health Policy and Management, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA. Electronic address: harsha@unc.edu.
2Department of Health Policy and Management, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA.
3RTI International, San Francisco, CA, USA.
4Department of Health Behavior, Gillings School of
Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill,
NC, USA.
5Impact Research and Development Organization, Kisumu,
Kenya.
Lancet HIV. 2016
Jun;3(6):e266-74. doi: 10.1016/S2352-3018(16)00041-2. Epub 2016 Apr 8.
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