Acceptability of unsupervised peer-based distribution of HIV oral self-testing for the hard-to-reach in rural KwaZulu Natal, South Africa: Results from a demonstration study

Abstract

Background Innovative models to distribute oral HIV self-tests (HIVST) provide an opportunity to increase access to HIV testing, especially for hard-to-reach populations. This study aimed to describe the acceptability of unsupervised peer-distribution of HIVST as a method to scale-up HIV testing. Methods In this study, lay counsellors or community health workers provided HIVST kits to primary recipients (PRs) for distribution to their sexual partners, anyone in their social network (termed secondary recipients) or for self-testing, from September 2018 to March 2020. The study was conducted in Eshowe and Mbongolwane areas in KwaZulu-Natal, South Africa. A structured questionnaire was administered during the recruitment and passive follow-up, when people came for confirmatory HIV testing. Electronic records were retrospectively examined to determine initiation of antiretroviral treatment (ART) for all HIVST users and non-users. Results Among 36,708 people approached to be primary recipients, 9,891 (26.9%) accepted; 31,341 HIVST kits were distributed with a median of three (IQR: 2–4) per peer. PRs were predominately recruited at primary health clinics (PHCs). However, acceptability of HIVST was thrice as high at community-based testing sites compared to PHCs (64.5% vs. 21.0%; p<0.001). During the study period, 34,715 adults were tested for HIV at both PHCs and community-based testing sites; of these, 1,089 individuals reported HIVST use. Among HIVST users, 893 (82.0%) returned to the clinic for confirmatory testing after testing negative on HIVST; 196 (17.9%) were confirmed HIV positive following a positive HIVST. After excluding 36/196 (18.4%) participants for whom clinical records could not be found in electronic register and 25/160 (15.6%) who were already on ART before receiving HIVST, 129/135 (95.5%) initiated ART, whereas 2,362/2685 (88%) of HIV positive HIVST non-users-initiated ART. Conclusion Unsupervised peer-distribution of HIVST was feasible and acceptable, with more than 25% accepting to be peer-distributors. Acceptability of HIVST was thrice as high in community sites compared to clinics.

Stakeholder-engaged development of a rapid test for detection of acute HIV infection

“…While participants expressed important bene ts and concerns for both end-user groups, the majority felt that CHW/peer-led testing would better meet the needs of high-risk populations, particularly regarding the need for counseling and navigation to care. These ndings supports a growing body of literature on the acceptability of both HIV community-based/peer-led and self-testing more broadly [37][38][39][40][41][42][43]. Several reviews have found that while interest in self-testing is high among vulnerable groups because of convenience and privacy, many are concerned about the reliability and accuracy of tests and post-test linkage to care and counseling [38][39][40].…”

Uptake of HIV Self-Testing and Associated Factors Among Female Sex Workers at Non-Governmental HIV Testing Facilities in Debre Markos and Bahir Dar Towns, Northwest Ethiopia, 2022

“…This is lower than some other studies conducted in Africa(70.4% in Nigeria, 18 74.5% in Senegal, 2 76.5% in Malawi 3 and 64.5% in South Africa). 19 HIVST uptake among FSW is considerably lower than the national requirement that was planned to be 95% based on UNAIDS 95-95-95 goals. 5 Furthermore, the result is consistent with a study conducted in Tanzania, which was 62.7%.…”

“…The magnitude of uptake of HIVST among FSWs in Nigeria, Senegal, and Malawi showed 70.4%, 18 74.5%, 2 and 76.5%, 3 respectively and a study done in South Africa revealed that HIVST uptake was 64.5%. 19 In Tanzania self-testing uptake was 62.7%. 5 …”

Social Network Strategies to Distribute HIV Self-testing Kits: A Global Systematic Review and Network Meta-analysis

“…Overall, 15 studies recruited index participants and encouraged participants to distribute them to people in their social networks (alters) [23–25, 27, 28, 30, 32, 33, 35, 39, 40, 43–45, 48]. Most studies had multiple HIVST kits provided directly to index participants by healthcare workers (HCWs) for distribution to alters.…”

“…Our network meta-analysis showed that HIV testing uptake was highest for distributing HIVST kits through peers and partners. Based on pre-existing contacts, peers and partners spontaneously distribute kits within their social networks [14, 32]. In contrast, peer educators were primarily randomly assigned to groups of recruited participants and then established connections for behavioral interventions [37, 41].…”