Background Despite the effective scale-up of HIV testing and treatment programs, only 75% of people living with HIV (PLWH) globally know their status, and this rate is lower among men. This highlights the importance of implementing HIV testing and linkage interventions with a high uptake in this population. In a cluster randomized controlled trial conducted in Kenya between 2013 and 2015, we found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH safely reached more HIV-exposed individuals with HIV testing compared with client referral alone. However, more data are needed to evaluate APS implementation in a real-world setting. Objective This study aims to evaluate the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. Methods Our study team from the University of Washington and PATH is integrating APS into 31 health facilities in Western Kenya. We are enrolling females newly diagnosed with HIV (index clients) who consent to receiving APS, their male sexual partners, and female sexual partners of male sexual partners who tested HIV positive. Female index clients and sexual partners testing HIV positive will be followed up at 6 weeks, 6 months, and 12 months postenrollment to assess linkage to care, antiretroviral therapy initiation, and HIV viral load suppression. We will evaluate the acceptability, fidelity, and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and subcounty-level policy makers responsible for HTS. Facility health staff providing HTS and APS, in addition to staff working with the study project team, will also be interviewed. We will also conduct direct observations of facility infrastructure and clinical procedures and extract data from the facilities and county and national databases. Results As of March 2020, we have recruited 1724 female index clients, 3201 male partners, and 1585 female partners. We have completed study recruitment as well as 6-week (2936/2973, 98.75%), 6-month (1596/1641, 97.25%), and 12-month (725/797, 90.9%) follow-up visits. Preliminary analyses show that facilities scaling up APS identify approximately 12-18 new HIV-positive males for every 100 men contacted and tested. We are currently completing the remaining follow-up interviews and incorporating an HIV self-testing component into the study in response to the COVID-19 pandemic. Conclusions The results will help bridge the gap between clinical research findings and real-world practice and provide guidance regarding optimal strategies for APS integration into routine HIV service delivery. International Registered Report Identifier (IRRID) DERR1-10.2196/27262

Introduction Healthcare worker training is essential to successful implementation of assisted partner services (aPS), which aims to improve HIV testing and linkage‐to‐care outcomes for previously unidentified HIV‐positive individuals. Cameroon, Kenya and Mozambique are three African countries that have implemented aPS programmes and are working to bring those programmes to scale. In this paper, we present and compare different aPS training strategies implemented by these three countries, and discuss facilitators and barriers associated with implementation of aPS training in sub‐Saharan Africa. Discussion aPS training programmes in Cameroon, Kenya and Mozambique share the following components: the development of comprehensive and interactive training curricula, recruitment of qualified trainees and trainers with intimate knowledge of the community served, continuous training, and rigorous monitoring and evaluation activities. Cameroon and Kenya were able to engage various stakeholders early on, establishing multilateral coalitions that facilitated attainment of long‐term buy‐in from the local governments. Ministries of Health and various implementing partners are often included in strategic planning and delivery of training curricula to ensure sustainability of the training programmes. Kenya and Mozambique have integrated aPS training into the national HTS guidelines, which are being rolled out nationwide by the Ministries of Health and implementing partners. Continual revision of training curricula to reflect the country context, as well as ongoing monitoring and evaluation, have also been identified as key facilitators to sustain aPS training programmes. Some of the barriers to scale‐up and sustainability of aPS training include limited funding and resources for training and scale‐up and shortage of aPS providers to facilitate on‐the‐job mentorship. Conclusions These three programmes demonstrate that aPS training can be implemented and scaled up in sub‐Saharan Africa. As countries plan for initial implementation or national scale‐up of aPS services, they will need to establish government buy‐in, expand funding sources, address the shortage of staff and resources to provide aPS and on‐the‐job mentorship, and continuously collect data to evaluate and improve aPS training plans. Development of national standards for aPS training, empowered healthcare providers, increased government commitment, and sustained funding for aPS services and training will be crucial for successful aPS implementation.

Background: Assisted partner services (aPS) involves notification and HIV testing for sexual partners of persons diagnosed HIV-positive (index clients). Because the impact of aPS is contingent on high acceptance, we assessed characteristics and reasons for nonenrollment among female index clients in an ongoing scale-up project. Methods: We analyzed data from HIV-positive females offered aPS in 31 facilities from May 2018 to August 2019. We compared sociodemographic characteristics by aPS enrollment (accepted, refused, and ineligible) and used multivariate binomial regression to assess associations between demographics and refusal. Results: Twenty-four thousand four hundred eighteen females received HIV testing and 1050 (4.3%) tested HIV-positive; 839 females enrolled in aPS (80%), 59 refused (6%), and 152 were ineligible (14%). APS uptake did not differ by age, testing history, or testing type (provider initiated vs. client initiated). Females refusing aPS were more likely to have completed secondary school [adjusted relative risk (aRR) 2.03, 95% confidence interval (CI): 1.13 to 2. 82] and be divorced/separated (aRR: 3.09, 95% CI: 1.39 to 6.86) or single (aRR: 2.66, 95% CI: 1.31 to 5.42) compared with married/cohabitating. Reasons for refusing aPS included not feeling emotionally ready (31%) and reporting no sexual partners in past 3 years (22%). Reasons for ineligibility included fear or risk of intimate partner violence (9%), previous HIV diagnosis (9%), or insufficient time for aPS provision (3%). Conclusions: APS has high acceptability among HIV-positive females regardless of age or testing history. More counseling may be needed to increase uptake among females with higher education and those who are separated/single. Follow-up for females not emotionally ready or who had insufficient time for aPS in their clinic visit can improve coverage.

BACKGROUND Despite the effective scale-up of HIV testing and treatment programs worldwide, only 75% of persons living with HIV (PLWH) globally know their status, with lower rates among men. This highlights the importance of implementing HIV testing and linkage interventions with high uptake in this population group. In a cluster randomized controlled trial conducted between 2013 and 2015, our team found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH, safely reached more at-risk individuals to conduct testing compared to client referral alone. However, more data is needed to assess APS implementation in a real-world setting. OBJECTIVE This study evaluates the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. METHODS In a collaboration between the University of Washington and PATH, we are integrating APS into 31 health facilities in Western Kenya and enrolling female index clients newly diagnosed with HIV who receive APS, their male sexual partners, and female sexual partners of the male sexual partners who test HIV positive. Female index clients and all sexual partners testing HIV-positive will be followed up at 6 weeks, 6 months, and 12 months to assess linkage to care, antiretroviral therapy (ART) initiation, and HIV viral load suppression. We will evaluate acceptability, fidelity and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and sub-county level policymakers responsible for HIV testing services. Facility health staff providing HIV testing services and APS, in addition to staff working with the study project team will also be interviewed. We will also conduct direct observations of facility infrastructure and clinic procedures, and extract data from facility and county/national databases. RESULTS As of March 2020, we have recruited 1724 index clients, 3201 male partners, and 1585 female partners. We have completed all recruitment for this study and have completed all 6-week (99%), 6-month (97%) and 12-month (91%) follow-up visits. Preliminary analyses demonstrate that through scaling-up APS, facilities are able to identify 12-18 new HIV-positive males for every 100 men contacted and tested. We are now in the process of completing the remaining follow-up interviews and building a self-testing component of the study as an adaptation to the COVID-19 pandemic. CONCLUSIONS Results will be used to bridge the gap between clinical research findings and everyday practice, and provide guidance on optimal strategies for APS integration into HIV service delivery. CLINICALTRIAL N/A