The Effects of Workplace-Based HIV Self-testing on Uptake of Testing and Linkage to HIV Care or Prevention by Men in Uganda (WISe-Men): Protocol for a Cluster Randomized Trial

Patience A Muwanguzi, Tom Denis Ngabirano, Noah Kiwanuka, LaRon E Nelson, Esther M Nasuuna, Charles Peter Osingada, Racheal Nabunya, Damalie Nakanjako, Nelson K Sewankambo, Patience A Muwanguzi, Tom Denis Ngabirano, Noah Kiwanuka, LaRon E Nelson, Esther M Nasuuna, Charles Peter Osingada, Racheal Nabunya, Damalie Nakanjako, Nelson K Sewankambo

Abstract

Background: HIV testing uptake remains low among men in sub-Saharan Africa. HIV self-testing (HIVST) at the workplace is a novel approach to increase the availability of, and access to, testing among men. However, both access and linkage to posttest services remain a challenge.

Objective: The aim of this protocol is to describe a cluster randomized trial (CRT)-Workplace-Based HIV Self-testing Among Men (WISe-Men)-to evaluate the effect of HIVST in workplace settings on the uptake of HIV testing services (HTS) and linkage to treatment and prevention services among men employed in private security services in Uganda.

Methods: This is a two-arm CRT involving men employed in private security services in two Ugandan districts. The participants in the intervention clusters will undergo workplace-based HIVST using OraQuick test kits. Those in the control clusters will receive routine HTS at their work premises. In addition to HTS, participants in both the intervention and control arms will undergo other tests and assessments, which include blood pressure assessment, blood glucose and BMI measurement, and rapid diagnostic testing for syphilis. The primary outcome is the uptake of HIV testing. The secondary outcomes include HIV status reporting, linkage into HIV care and confirmatory testing following HIVST, initiation of antiretroviral therapy following a confirmatory HIV test, the uptake of voluntary medical male circumcision, consistent condom use, and the uptake of pre-exposure prophylaxis by the most at-risk populations.

Results: Participant enrollment commenced in February 2020, and the trial is still recruiting study participants. Follow-up for currently enrolled participants is ongoing. Data collection and analysis is expected to be completed in December 2021.

Conclusions: The WISe-Men trial will provide information regarding whether self-testing at worksites increases the uptake of HIV testing as well as the linkage to care and prevention services at male-dominated workplaces in Uganda. Additionally, the findings will help us propose strategies for improving men's engagement in HTS and ways to improve linkage to further care following a reactive or nonreactive HIVST result.

Trial registration: ClinicalTrials.gov NCT04164433; https://ichgcp.net/clinical-trials-registry/NCT04164433.

International registered report identifier (irrid): DERR1-10.2196/25099.

Keywords: Africa; HIV self-testing; linkage to care; linkage to prevention; workplace HIV testing.

Conflict of interest statement

Conflicts of Interest: None declared.

©Patience A Muwanguzi, Tom Denis Ngabirano, Noah Kiwanuka, LaRon E Nelson, Esther M Nasuuna, Charles Peter Osingada, Racheal Nabunya, Damalie Nakanjako, Nelson K Sewankambo. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 01.11.2021.

Figures

Figure 1
Figure 1
Conceptual model adapted from the information-motivation-behavioral skills model. HIVST: HIV self-testing; HTS: HIV testing services; PrEP: pre-exposure prophylaxis; VMMC: voluntary medical male circumcision.
Figure 2
Figure 2
Cluster randomized trial flow diagram. HIVST: HIV self-testing; RDT: rapid diagnostic test.
Figure 3
Figure 3
HIV self-testing (HIVST) pathway.
Figure 4
Figure 4
Serial HIV testing algorithm for testing persons over 18 months of age in Uganda.

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