Ease of understanding and performing HIV self-tests by pregnant women and their male partners in Uganda: a cross-sectional study

Abstract

Introduction: Understanding and following HIV self-testing (HIVST) instructions is a critical step in the use of HIVST kits. We analyzed data on pregnant women and their partners’ self-assessment on the usability of kits delivered by their pregnant women. Methods: Quantitative data were collected on 399 pregnant women and 238 male partners enrolled in the intervention arm of a large cluster-randomized HIVST trial. Each pregnant woman received HIVST demonstrations, detailed pictorial instructions on how to use OraQuick HIVST kits, and two kits; for herself and her male partner. Follow-up was at one month (baseline for male partners) and 3 months. Descriptive statistics were conducted to compare understanding and following of HIVST instructions by age and education level. Results: The proportion of those who understood HIVST instructions was almost the same (98%) for women and their partners, although partners (26.5%) were nearly twice as likely than women (16.0%) to report needing pretest counseling (Odds ratio [OR] = 1.9, 95% CI: 1.27–2.79). Partners’ understanding of the HIVST instructions did not vary by education level, but 4.4% of women with primary education reported difficulty in understanding HIVST instructions compared with 0.5% and 0% of those with secondary and university education, respectively ( p = 0.05). However, 5.6% of women aged 30–68 years and 3.3% of partners aged 20–24 years found it more difficult to understand the HIVST instructions. Conclusion: Both pregnant women and their male partners were correctly able to perform an HIVST without or (with minimal) support suggesting that this mode of delivery will help the national program reach more men. Because more male partners than women required HIVST pretest counseling support, male-targeted HIVST promotional messages may be needed to increase men's self-efficacy to perform HIVST unsupported.

A randomized trial of index HIV self-testing for sexual partners of ART clients in Malawi

“…The limited data available on the usability of secondary HIVST show that most partners are able to complete a HIVST test successfully, but some require guidance, desire pre-test counseling, or mistrust HIVST results. 24,37 Additional research is needed to identify strategies that facilitate accurate test interpretation within secondary distribution models, such as additional visual aids and/or wider community sensitization about HIVST. This is one of the first studies to examine ART initiation among HIVST users longitudinally.…”

“…35,36 A package of strategies may be needed in order to optimally reach male partners, such as index HIVST plus peer support for men or male targeted promotional messaging. 24,37 In addition, other entry points such as outpatient departments, the only facility-based entry point reached by most men, may need to be utilized further to reach men.…”

Effect of index HIV self-testing for sexual partners of clients enrolled in antiretroviral therapy (ART) programs in Malawi: A randomized controlled trial

“…A sub-analysis of our data showed large testing differences by sex-in the HIVST arm 89% of female partners tested versus 67% of male partners. This disparity is important as index testing represents a key strategy for reaching men, who comprised over 78% of eligible index partners and have few additional entry points into HIV services [37][38][39]. Strategies to engage men must be prioritized, including HIV testing and linkage to additional services after testing [11].…”

“…Strategies to engage men must be prioritized, including HIV testing and linkage to additional services after testing [11]. A package of strategies may be needed in order to optimally reach male partners, such as index HIVST plus peer support for men or male targeted promotional messaging [29,38]. In addition, other entry points such as outpatient departments, the only facility-based entry point reached by most men, may need to be utilized further to reach men.…”

“…Understanding the usability of HIVST within index testing is critical to ensuring the strategy is effective and scalable in low-resource settings, particularly where health literacy is low. The limited data available on the usability of secondary HIVST show that most partners are able to complete an HIVST test successfully, but some require guidance, desire pre-test counseling, or mistrust HIVST results [24,38]. Additional research is needed to identify strategies that facilitate accurate test interpretation within secondary distribution models, such as additional visual aids and/or wider community sensitization about HIVST.…”