Evaluating oral HIV self-testing to increase HIV testing uptake among truck drivers in Kenya

Kelvin, Elizabeth A.; Mwai, Eva; Romo, Matthew L.; George, Gavin; Govender, Kaymarlin; Mantell, Joanne E.; Strauss, M.; Nyaga, Eston; Odhiambo, Jacob

doi:10.23846/tw2206

Cited by 6 publications

(16 citation statements)

References 7 publications

(7 reference statements)

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“…Those in the intervention arm in which self-testing was offered as a choice had 2.8 times higher odds of testing compared with those in the SOC arm (Kelvin et al 2017a;. Thus, the relative increase in testing rate is fairly consistent across the two studies, which differed in terms of how the self-test was initially introduced (by the counselor when the client was already in the clinic versus via text message) and in terms of HIV testing history of the participants.…”

Section: Discussionmentioning

confidence: 96%

“…HIV testing rates were significantly higher in the intervention group at the first offer of testing (OR = 2.8, p = 0.002) (Kelvin et al 2017a;, but there was no difference during the six-month follow-up (OR = 1.0, p = 0.972) (Kelvin et al 2017a).…”

Section: Introductionmentioning

confidence: 87%

“…Another reason might be (2) since HIV testing rates and frequency were high in this sample (92% had HIV tested at some time in the past and the median time since last test was 6 months) and a high proportion tested at the first offer of testing (72.9% in SOC and 87.3% in intervention groups), few participants may have felt they needed another test by the six-month follow-up, thus maybe self-testing would have a greater impact among non-regular or infrequent testers. In fact, only 57 participants who completed follow-up had not tested at the first HIV test offer and while they were more likely to test over follow-up (63.4% versus 54.2% of those who had tested, p = 0.236), the difference was not statistically significant, likely due to the small number (Kelvin et al 2017a).…”

Section: Introductionmentioning

confidence: 88%

“…Eligibility criteria for each sample were: (1) No indication that they were HIV-positive; (2) resident in Kenya; (3) had a valid cell phone number listed; (4) had fewer than 4 HIV tests in the past 12 months (indicating that they were not following the recommendation to test every 3 months for 4 tests per year); (5) had not had an HIV test in the past 3 months; (6) had not participated in our previous study on self-administered HIV testing (Kelvin et al 2017a;; and (7) had an indication of male sex and trucker (driver or assistant) or female sex and sex worker.…”

Section: Sample Eligibility Criteria and Consentmentioning

confidence: 99%

“…The work-related separation associated with truck driving may lead many to patronize commercial sex services or have multiple non-commercial partnerships along the trucking route. A recent study among 3,805 truckers in Kenya found that 55.9% had paid for sex in the past 6 months and 46.6% had a regular partner along their trucking route in addition to a wife or girlfriend at home (Kelvin et al 2017a;. HIV prevalence is often higher among FSWs compared with the general population, making the use of commercial sex services a risk factor for infection.…”

Section: Introductionmentioning

confidence: 99%

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The effect of conditional transfers on intimate partner violence: evidence from Northern Ecuador

Hidrobo¹,

Peterman²,

Heise³

2016

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The objective of this randomized controlled trial was to assess whether making HIV selftest kits available as a testing option at North Star Alliance roadside wellness clinics in Kenya and advertising their availability via SMS (text message) would increase HIV testing rates among truckers and sex workers who were irregular testers, compared with sending text messages about HIV testing in general. A sample of 2,262 male truckers and 2,196 female sex workers registered in the North Star Alliance electronic medical record system and who, based on these records, were irregular HIV testers were randomized to one of three study arms in which they were sent text messages about the HIV testing available to them at North Star Alliance Kenya clinics. Specifically, the different arms received a text, either: (1) communicating the availability of HIV self-test kits at all North Star Alliance Kenya clinics, which was sent three times (intervention); (2) about the availability of HIV testing in general at North Star Alliance clinics, sent three times (enhanced standard of care (SOC)); or (3) about HIV testing at North Star Alliance clinics in general, sent once (SOC). When arriving at a North Star Alliance clinic in Kenya, those in the enhanced SOC and SOC groups were only offered one HIV test, the standard provider-administered rapid finger-prick blood HIV test. Those in the intervention group, when arriving in a clinic, were offered a choice between (1) the SOC HIV test; (2) a rapid oral HIV self-test for self-administration in the clinic with supervision; or (3) the rapid oral HIV self-test kit to take for home use with phone-based post-test counseling. We followed each sample for two months and looked at differences in HIV testing using logistic regression. Truckers and sex workers in the intervention arm were significantly more likely to test for HIV during follow-up compared with those in the enhanced SOC (OR = 2.7, p = 0.007 and OR = 1.9, p = 0.001 respectively). There was no difference in HIV testing between those in the enhanced SOC and the SOC arms for either sample. The intervention proved to be more cost effective than either the enhanced SOC or the SOC, even though the HIV self-test kits cost much more than the standard provider-administered HIV test because of the higher HIV testing rates in the intervention arm. Offering HIV self-testing to high-risk populations such as truckers and sex workers and advertising its availability via text message may be a cost-effective way to increase HIV testing rates in these important groups.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 88%

Section: Sample Eligibility Criteria and Consentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The effect of conditional transfers on intimate partner violence: evidence from Northern Ecuador

Hidrobo¹,

Peterman²,

Heise³

2016

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The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya

Mujwara,

Kelvin,

Dahman

et al. 2024

Health Policy and Planning

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HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared to provider-administered testing only (standard-of-care (SOC)) among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n=150; SOC arm, n=155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared to SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$ 39.28) versus SOC (I$ 10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.

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Self-testing knowledge and beliefs on HIV self-testing use in central Uganda

Nsereko,

Kobusingye,

Musanje

et al. 2024

Preprint

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The government of Uganda and its implementing partners have made significant investments in HIV self-testing (HST) services as a strategy to reduce clinic related barriers to HIV testing. However, although HSTs have been around for a reasonable time, their uptake especially among unskilled working individuals has remained sub-optimal which threatens the efforts to achieve the 95-95-95 UNAIDS goals to end HIV by 2030. This study set out to examine whether knowledge and individual beliefs about self-testing influence usage of HIV self-tests among causal workers in Kampala. This was a cross-sectional study utilizing 453 participants; 53% females, 29.2% aged (22-25)22 to 25, and 40.6% attended high school education. These were selected through systematic random sampling from Darling Uganda Ltd in Wakiso district. Standardized questionnaires were used, and analysis done with Pearson Correlations and Multiple Regression in SPSS. The findings indicate that HIV self-testing (HST) knowledge was positively related to HST use (r=.387, p<=.01); perceived susceptibility (r=.212, p<=.01); perceived benefits (r=.152, p<=.01) and perceived barriers (r=.101, p<=.05). Individual beliefs, that is, perceived susceptibility (r=.355, p<=.01); perceived benefits (r=.487, p<=.01); and perceived barriers (r=.148, p<=.01) are significantly related to HST use. Perceived benefits were the overall best predictors of HST use among this population (β=.442, p=.000). Therefore, (44.2%) of HST use is attributed to the benefits attached to the service. Therefore, increasing awareness regarding the benefits of HST among such populations increases the chances of HIV testing especially among men. This can pave the way to the 95-95-95 goal by 2030 of UNAIDS.

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Evaluating oral HIV self-testing to increase HIV testing uptake among truck drivers in Kenya

Cited by 6 publications

References 7 publications

The effect of conditional transfers on intimate partner violence: evidence from Northern Ecuador

The effect of conditional transfers on intimate partner violence: evidence from Northern Ecuador

The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya

Self-testing knowledge and beliefs on HIV self-testing use in central Uganda

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