Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial

Samuel H Masters, Kawango Agot, Beatrice Obonyo, Sue Napierala Mavedzenge, Suzanne Maman, Harsha Thirumurthy, Samuel H Masters, Kawango Agot, Beatrice Obonyo, Sue Napierala Mavedzenge, Suzanne Maman, Harsha Thirumurthy

Abstract

Background: Achieving higher rates of partner HIV testing and couples testing among pregnant and postpartum women in sub-Saharan Africa is essential for the success of combination HIV prevention, including the prevention of mother-to-child transmission. We aimed to determine whether providing multiple HIV self-tests to pregnant and postpartum women for secondary distribution is more effective at promoting partner testing and couples testing than conventional strategies based on invitations to clinic-based testing.

Methods and findings: We conducted a randomized trial in Kisumu, Kenya, between June 11, 2015, and January 15, 2016. Six hundred antenatal and postpartum women aged 18-39 y were randomized to an HIV self-testing (HIVST) group or a comparison group. Participants in the HIVST group were given two oral-fluid-based HIV test kits, instructed on how to use them, and encouraged to distribute a test kit to their male partner or use both kits for testing as a couple. Participants in the comparison group were given an invitation card for clinic-based HIV testing and encouraged to distribute the card to their male partner, a routine practice in many health clinics. The primary outcome was partner testing within 3 mo of enrollment. Among 570 participants analyzed, partner HIV testing was more likely in the HIVST group (90.8%, 258/284) than the comparison group (51.7%, 148/286; difference = 39.1%, 95% CI 32.4% to 45.8%, p < 0.001). Couples testing was also more likely in the HIVST group than the comparison group (75.4% versus 33.2%, difference = 42.1%, 95% CI 34.7% to 49.6%, p < 0.001). No participants reported intimate partner violence due to HIV testing. This study was limited by self-reported outcomes, a common limitation in many studies involving HIVST due to the private manner in which self-tests are meant to be used.

Conclusions: Provision of multiple HIV self-tests to women seeking antenatal and postpartum care was successful in promoting partner testing and couples testing. This approach warrants further consideration as countries develop HIVST policies and seek new ways to increase awareness of HIV status among men and promote couples testing.

Trial registration: ClinicalTrials.gov NCT02386215.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Assessment of eligibility, randomization, and…
Fig 1. Assessment of eligibility, randomization, and follow-up.
HIVST, HIV self-testing.

References

    1. UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.
    1. Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, et al. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med. 2013;10(8):e1001496 Epub 2013/08/24. PubMed Central PMCID: PMC3742447. 10.1371/journal.pmed.1001496
    1. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528(7580):S77–85. 10.1038/nature16044
    1. Gelmon L, Kenya P, Oguya F, Cheluget B, Haile G. Kenya HIV prevention response and modes of transmission analysis Nairobi: Kenya National AIDS Control Council; 2009.
    1. Allen S, Meinzen-Derr J, Kautzman M, Zulu I, Trask S, Fideli U, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17(5):733–40. 10.1097/01.aids.0000050867.71999.ed
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. 10.1056/NEJMoa1105243
    1. Aluisio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C. Male antenatal attendance and HIV testing are associated with decreased infant hiv infection and increased HIV free survival. J Acquir Immune Defic Syndr. 2011;56(1):76–82. 10.1097/QAI.0b013e3181fdb4c4
    1. Drake AL, Wagner A, Richardson B, John-Stewart G. Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis. PLoS Med. 2014;11(2):e1001608 10.1371/journal.pmed.1001608
    1. Medley A, Baggaley R, Bachanas P, Cohen M, Shaffer N, Lo Y-R. Maximizing the impact of HIV prevention efforts: interventions for couples. AIDS Care. 2013;25(12):1569–80. 10.1080/09540121.2013.793269
    1. World Health Organization. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: recommendations for a public health approach Geneva: World Health Organization; 2012.
    1. Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 2004;37(5):1620–6. Epub 2004/12/04. PubMed Central PMCID: PMCPmc3384734.
    1. Msuya SE, Mbizvo EM, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B. Low male partner participation in antenatal HIV counselling and testing in northern Tanzania: implications for preventive programs. AIDS Care. 2008;20(6):700–9. Epub 2008/06/26. 10.1080/09540120701687059
    1. Obermeyer CM, Osborn M. The utilization of testing and counseling for HIV: a review of the social and behavioral evidence. Am J Public Health. 2007;97(10):1762–74. Epub 2007/09/01. PubMed Central PMCID: PMCPMC1994175. 10.2105/AJPH.2006.096263
    1. Hutchinson AB, Corbie-Smith G, Thomas SB, Mohanan S, del Rio C. Understanding the patient’s perspective on rapid and routine HIV testing in an inner-city urgent care center. AIDS Educ Prev. 2004;16(2):101–14. Epub 2004/05/12.
    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 10.1371/journal.pmed.1001102
    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(11):1949–65. PubMed Central PMCID: PMC4598350. 10.1007/s10461-015-1097-8
    1. Napierala Mavedzenge S, Baggaley R, Corbett EL. A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention. Clin Infect Dis. 2013;57(1):126–38. 10.1093/cid/cit156
    1. Choko AT, MacPherson P, Webb EL, Willey BA, Feasy H, Sambakunsi R, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in Blantyre, Malawi: a community-based prospective study. PLoS Med. 2015;12(9):e1001873 Epub 2015/09/09. PubMed Central PMCID: PMCPmc4562710. 10.1371/journal.pmed.1001873
    1. National AIDS and STI Control Programme. Guidelines for HIV testing services in Kenya Nairobi: National AIDS and STI Control Programme; 2015.
    1. World Health Organization. Consolidated guidelines on HIV testing services Geneva: World Health Organization; 2015.
    1. National AIDS and STI Control Programme, Ministry of Public Health and Sanitation. Guidelines for HIV testing and counselling in Kenya Nairobi: National AIDS and STI Control Programme; 2010.
    1. Thirumurthy H, Masters S, Napierala Mavedzenge S, Maman S, Omanga E, Agot A. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV. 2016;3(6):e266–74. 10.1016/S2352-3018(16)00041-2
    1. National AIDS and STI Control Programme. Kenya HIV county profiles Nairobi: Ministry of Health; 2014.
    1. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6. Epub 2004/03/23.
    1. Kenya National Bureau of Statistics, ICF Macro. Kenya Demographic and Health Survey 2008–09. Calverton (Maryland): ICF Macro; 2010.
    1. Osoti AO, John-Stewart G, Kiarie J, Richardson B, Kinuthia J, Krakowiak D, et al. Home visits during pregnancy enhance male partner HIV counselling and testing in Kenya: a randomized clinical trial. AIDS. 2014;28(1):95–103. Epub 2013/08/15. PubMed Central PMCID: PMCPmc4337402. 10.1097/QAD.0000000000000023
    1. Rosenberg NE, Mtande TK, Saidi F, Stanley C, Jere E, Paile L, et al. Recruiting male partners for couple HIV testing and counselling in Malawi’s option B+ programme: an unblinded randomised controlled trial. Lancet HIV. 2015;2(11):e483–91. 10.1016/S2352-3018(15)00182-4
    1. Ng’ang’a A, Waruiru W, Ngare C, Ssempijja V, Gachuki T, Njoroge I, et al. The status of HIV testing and counseling in Kenya: results from a nationally representative population-based survey. J Acquir Immune Defic Syndr. 2014;66(Suppl 1):S27–36. Epub 2014/04/16. 10.1097/QAI.0000000000000102
    1. Kimanga DO, Ogola S, Umuro M, Ng’ang’a A, Kimondo L, Murithi P, et al. Prevalence and incidence of HIV infection, trends, and risk factors among persons aged 15–64 years in Kenya: results from a nationally representative study. J Acquir Immune Defic Syndr. 2014;66(Suppl 1):S13–26. PubMed Central PMCID: PMCPMC4794992. 10.1097/QAI.0000000000000124
    1. Carballo-Dieguez A, Frasca T, Balan I, Ibitoye M, Dolezal C. Use of a rapid HIV home test prevents HIV exposure in a high risk sample of men who have sex with men. AIDS Behav. 2012;16(7):1753–60. Epub 2012/08/16. PubMed Central PMCID: PMC3458207. 10.1007/s10461-012-0274-2
    1. Carballo-Dieguez A, Frasca T, Dolezal C, Balan I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res. 2012;49(4):379–87. Epub 2012/02/02. 10.1080/00224499.2011.647117

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera