Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

Waimar Tun, Lung Vu, Osasuyi Dirisu, Adekemi Sekoni, Elizabeth Shoyemi, Jean Njab, Sade Ogunsola, Sylvia Adebajo, Waimar Tun, Lung Vu, Osasuyi Dirisu, Adekemi Sekoni, Elizabeth Shoyemi, Jean Njab, Sade Ogunsola, Sylvia Adebajo

Abstract

Introduction: HIV self-testing (HIVST) offers an alternative to facility-based HIV testing services, particularly for populations such as men who have sex with men (MSM) who may fear accessing testing due to stigma, discrimination and criminalization. Innovative HIV testing approaches are needed to meet the goal of 90% of people living with HIV being diagnosed. This study piloted an intervention to distribute oral HIVST kits to MSM through key opinion leaders (KOLs) in Lagos, Nigeria and assessed the feasibility, acceptability, uptake of HIVST and linkage to HIV treatment.

Methods: A cohort study was conducted (May through September 2017) with 319 participants who were recruited by 12 KOLs through their networks. A baseline survey was conducted at the time of the oral HIVST kit (OraQuick® HIV antibody test) distribution to eligible MSM followed by a 3-month follow-up survey to assess usage of and experience with the HIVST kits. Each participant was given two kits.

Results: The median age of the participants was 25 years, 88.7% were literate and 17.9% were first-time testers. Of the 257 participants (80.7% retention) who completed the three-month follow-up interview, 97.7% reported using the HIVST kit and 14 (5.6%) self-reported an HIV positive result. A quarter (22.7%) tested themselves the same day they received the kit, and 49.4% tested within one week. Almost all participants reported that the HIVST kit instructions were easy or somewhat easy to understand (99.6%) and perform the test (98.0%). The most common reasons they liked the test were ease of use (87.3%), confidentiality/privacy (82.1%), convenience (74.1%) and absence of needle pricks (64.9%). All 14 participants who tested positive had sought confirmatory testing and initiated HIV treatment by the time of the three-month survey.

Conclusions: HIVST distribution through KOLs was feasible and oral self-testing was highly acceptable among this urban MSM population. Despite concerns about linkage to treatment when implementing self-testing, this study showed that linkage to treatment can be achieved with active follow-up and access to a trusted MSM-friendly community clinic that offers HIV treatment. HIVST should be considered as an additional option to standard HIV testing models for MSM.

Keywords: HIV; MSM; HIV positivity rate; Nigeria; feasibility; linkage to treatment; self-testing.

© 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Figures

Figure 1
Figure 1
Places where participants were willing to obtain HIV self‐testing (HIVST) kits (N = 319)

References

    1. UNAIDS . 90‐90‐90: an ambitious treatment target to help end the AIDS epidemic . Geneva, Switzerland:UNAIDS; 2014.
    1. Schwartz SR, Nowak RG, Orazulike I, Keshinro B, Ake J, Kennedy S, et al. The immediate effect of the Same‐Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort. Lancet HIV. 2015;2(7):e299–306.
    1. Vu L, Tun W, Sheehy M, Nel D. Levels and correlates of internalized homophobia among men who have sex with men in pretoria. South Africa. AIDS Behav. 2012;16(3):717–23.
    1. Fay H, Baral SD, Trapence G, Motimedi F, Umar E, Iipinge S, et al. Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana. AIDS Behav. 2011;15(6):1088–97.
    1. Wei C, Cheung DH, Yan H, Li J, Shi LE, Raymond HF. The impact of homophobia and HIV Stigma on HIV testing uptake among Chinese men who have sex with men: a mediation analysis. J Acquir Immune Defic Syndr. 2016;71(1):87–93.
    1. Cloete A, Kalichman SC, Simbayi LC. Layered Stigma and HIV/AIDS: experiences of men who have sex with men (MSM) in South Africa In Liamputtong P, editor. Stigma, Discrimination and Living with HIV/AIDS. Dordrecht: Springer; 2013. p. 259–69
    1. Risher K, Adams D, Sithole B, Ketende S, Kennedy C, Mnisi Z, et al. Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland. J Int AIDS Soc. 2013;16(3 Suppl 2):18715.
    1. Vu L, Adebajo S, Tun W, Sheehy M, Karlyn A, Njab J, et al. High HIV prevalence among men who have sex with men in Nigeria: implications for combination prevention. J Acquir Immune Defic Syndr. 2013;63(2):221–7.
    1. Keshinro B, Crowell TA, Nowak RG, Adebajo S, Peel S, Gaydos CA, et al. High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria. J Int AIDS Soc. 2016;19(1):21270.
    1. National HIV/AIDS & STI Control Porgramme, Federal Ministry of Health, Nigeria . Integrated Biological and Behavioural Surveillance Survey (IBBSS) 2014. 2014.
    1. Federal Ministry of Health, Nigeria . Integrated Biological and Behavioural Surveillance Survey 2010.
    1. World Health Organization . Guidelines on HIV Self‐Testing and Partner Notification (Supplement to Consolidated Guideline on HIV Testing Services). Geneva, Switzerland: World Health Organization; 2016.
    1. Vu L, Andrinopoulos K, Tun W, Adebajo S. High levels of unprotected anal intercourse and never testing for HIV among men who have sex with men in Nigeria: evidence from a cross‐sectional survey for the need for innovative approaches to HIV prevention. Sex Transm Infect. 2013;89(8):659–65.
    1. Johnson CC, Corbett EL. HIV self‐testing to scale up couples and partner testing. Lancet HIV. 2016;3(6):e243–4.
    1. Yan H, Yang H, Raymond HF, Li J, Shi LE, Huan X, et al. Experiences and correlates of HIV self‐testing among men who have sex with men in Jiangsu province. China. AIDS Behav. 2015;19(3):485–91.
    1. Han L, Bien CH, Wei C, Muessig KE, Yang M, Liu F, et al. HIV self‐testing among online MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr. 2014;67(2):216–21.
    1. Heard AC, Brown AN. Public readiness for HIV self‐testing in Kenya. AIDS Care. 2016:1–5.
    1. Johnson C, Baggaley R, Forsythe S, Van Rooyen H, Ford N, Mavedzenge SN, et al. Realizing the potential for HIV self‐testing. AIDS Behav. 2014;18(Suppl 4):S391–5.
    1. Kelvin EA, Cheruvillil S, Christian S, Mantell JE, Milford C, Rambally‐Greener L, et al. Afr J AIDS Res. 2016;15(2):99–108.
    1. Krause J, Subklew‐Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self‐testing: a systematic literature review. BMC Public Health. 2013;13:735.
    1. Lippman SA, Périssé AR, Veloso VG, Sullivan PS, Buchbinder S, Sineath RC, et al. Acceptability of self‐conducted home‐based HIV testing among men who have sex with men in Brazil: data from an on‐line survey. Cad Saude Publica. 2014;30(4):724–34.
    1. Pérez GM, Cox V, Ellman T, Moore A, Patten G, Shroufi A, et al., . I know that i do have hiv but nobody saw me’: oral HIV self‐testing in an informal settlement in South Africa. PLoS ONE. 2016;11(4):e0152653.
    1. Sun CJ, Stowers J, Miller C, Bachmann LH, Rhodes SD, Rhodes SD. . Acceptability and feasibility of using established geosocial and sexual networking mobile applications to promote HIV and STD testing among men who have sex with men. AIDS Behav. 2015;19(3):543–52.
    1. Tao J, Li MY, Qian HZ, Wang LJ, Zhang Z, Ding HF, et al. Home‐based HIV testing for men who have sex with men in China: a novel community‐based partnership to complement government programs. PLoS ONE. 2014;9(7):e102812.
    1. Tucker JD, Wei C, Pendse R, Lo YR. HIV self‐testing among key populations: an implementation science approach to evaluating self‐testing. J Virus Erad. 2015;1(1):38–42.
    1. Martínez Pérez G, Steele SJ, Govender I, Arellano G, Mkwamba A, Hadebe M, et al. Supervised oral HIV self‐testing is accurate in rural KwaZulu‐Natal, South Africa. Trop Med Int Health, 2016. 21(6): 759–67.
    1. Pai NP, Balram B, Shivkumar S, Martinez‐Cajas JL, Claessens C, Lambert G, et al. Head‐to‐head comparison of accuracy of a rapid point‐of‐care HIV test with oral versus whole‐blood specimens: a systematic review and meta‐analysis. Lancet Infect Dis. 2012;12(5):373–80.
    1. Pai NP, Joshi R, Dogra S, Taksande B, Kalantri SP, Pai M, et al. Evaluation of diagnostic accuracy, feasibility and client preference for rapid oral fluid‐based diagnosis of HIV infection in rural India. PLoS ONE. 2007;2(4):e367.
    1. Pai NP, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L, et al. Supervised and unsupervised self‐testing for HIV in high‐ and low‐risk populations: a systematic review. PLoS Med. 2013;10(4):e1001414.
    1. Choko AT, Desmond N, Webb EL, Chavula K, Napierala‐Mavedzenge S, Gaydos CA, et al. The uptake and accuracy of oral kits for HIV self‐testing in high HIV prevalence setting: a cross‐sectional feasibility study in Blantyre, Malawi. PLoS Med. 2011;8(10):e1001102.
    1. Green K., Bao VN, Huong PTT, Son VH, Giang HTT, Ha TT, et al., Is HIV self‐testing acceptable to key populations in Vietnam? Results from a cross‐sectional study of men who have sex with men, female sex workers and people who inject drugs., In 21th International AIDS Conference (AIDS 2016) 2016: Durban, South Africa.
    1. Katz DA, Cassels SL, Stekler JD. Replacing clinic‐based tests with home‐use tests may increase HIV prevalence among Seattle men who have sex with men: evidence from a mathematical model. Sex Transm Dis. 2014;41(1):2–9.
    1. Herbst JH, Sherba RT, Crepaz N, DeLuca JB, Zohrabyan L, Stall RD, et al. A meta‐analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr. 2005;39(2):228–41.
    1. Beck AT, Beck RW. Screening depressed patients in family practice: a rapid technic. Postgrad Med. 1972;52:81–5.
    1. Gile KJ. Improved inference for respondent‐driven sampling data with application to HIV prevalence estimation. J Am Stat Assn. 2011;106(493):135–46.
    1. Pant Pai N, Behlim T, Abrahams L, Vadnais C, Shivkumar S, Pillay S, et al. Will an unsupervised self‐testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study. PLoS ONE, 2013. 8(11): e79772.
    1. Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and acceptability on HIV self‐testing among key populations: a literature review. AIDS Behav. 2015;19:1949–65.
    1. Merrigan M, Azeez A, Afolabi B, Chabikuli ON, Onyekwena O, Eluwa G, et al. HIV prevalence and risk behaviours among men having sex with men in Nigeria. Sex Transm Infect. 2011;87(1):65–70.
    1. Peck RB, Lim JM, van Rooyen H, Mukoma W, Chepuka L, Bansil P, et al. What should the ideal HIV self‐test look like? A usability study of test prototypes in unsupervised HIV self‐testing in Kenya, Malawi, and South Africa. AIDS Behav. 2014;18(Suppl 4):S422–32.
    1. Kurth AE, Cleland CM, Chhun N, Sidle JE, Were E, Naanyu V, et al. Accuracy and acceptability of oral fluid HIV self‐testing in a general adult population in Kenya. AIDS Behav. 2016;20(4):870–9.
    1. Hector J, Davies MA, Dekker‐Boersema J, Aly MM, Abdalad CCA, Langa EBR, et al. Acceptability and performance of a directly assisted oral HIV self‐testing intervention in adolescents in rural Mozambique. PLoS ONE. 2018;13(4):e0195391.
    1. Chanda MM, Ortblad KF, Mwale M, Chongo S, Kanchele C, Kamungoma N, et al. HIV self‐testing among female sex workers in Zambia: a cluster randomized controlled trial. PLoS Med. 2017;14(11):e1002442.
    1. Kalibala S, Tun W, Cherutich P, Nganga A, Oweya E, Oluoch P. Factors associated with acceptability of HIV self‐testing among health care workers in Kenya. AIDS Behav. 2014;18(Suppl 4):S405–14.
    1. Ngure K, Heffron R, Mugo N, Thomson KA, Irungu E, Njuguna N, et al. Feasibility and acceptability of HIV self‐testing among pre‐exposure prophylaxis users in Kenya. J Int AIDS Soc. 2017;20(1):21234.
    1. Bain LE, Ditah CM, Awah PK, Ekukwe NC. Ethical implications of HIV self‐testing: the game is far from being over. Pan Afr Med J. 2016;25:114.
    1. Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis. J Int AIDS Soc. 2017;20(1):21594.
    1. UNAIDS . UNAIDS Data 2017. Geneva, Switzerland: 2017.
    1. Ren XL, Wu ZY, Mi GD, McGoogan JM, Rou KM, Zhao Y, et al. HIV care‐seeking behaviour after HIV self‐testing among men who have sex with men in Beijing, China: a cross‐sectional study. Infect Dis Poverty. 2017;6(1):112.
    1. Qin Y, Tang W, Nowacki A, Mollan K, Reifeis SA, Hudgens MG, et al. Benefits and potential harms of human immunodeficiency virus self‐testing among men who have sex with men in China: an implementation perspective. Sex Transm Dis. 2017;44(4):233–8.
    1. Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, et al. Acceptability and feasibility of a social entrepreneurship testing model to promote HIV self‐testing and linkage to care among men who have sex with men. HIV Med. 2017;18(5):376–82.
    1. Volk JE, Lippman SA, Grinsztejn B, Lama JR, Fernandes NM, Gonzales P, et al. Acceptability and feasibility of HIV self‐testing among men who have sex with men in Peru and Brazil. Int J STD AIDS. 2016;27(7):531–6.

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