HIV Oral Self-Testing for Male Partners of Women Attending Antenatal Care in Central Uganda: Uptake of Testing and Linkage to Care in a Randomized Trial

Abstract

Background: In Uganda, HIV testing rates are approximately 90% among women in antenatal care, with male rates much lower. The World Health Organization has recommended HIV self-testing (HIVST), and one promising model is for women in antenatal care to deliver HIVST kits to their male partners. We investigated the impact of this model on male partner testing rates. Setting: Three high-volume antenatal clinics in central Uganda. Methods: We implemented a cluster-randomized controlled trial comparing standard of care to intervention, with the primary outcome of self-reported male partner HIV testing. Women and male partners were followed at 1 and 3 months. We used unadjusted analyses and log-linear models with an intent-to-treat approach accounting for clustering. Results: Study coordinators randomized 1514 women (777 intervention and 737 control). Baseline characteristics were balanced across arms with mean age (SD) of 25.2 (5.5) years and >44% with secondary education or higher. More male partners tested for HIV in intervention [576/746 (77.2%)] versus control [264/709 (37.2%)], P < 0.01. We identified 34 HIV-positive men in intervention versus 10 in control, with 6/26 (23%) and 4/6 (67%), respectively, reporting linking to care. Conclusions: Our results demonstrate an enormous increase in self-reported partner HIV testing when HIVST is available at home. However, men testing positive through HIVST appeared less likely to link to care than men testing positive at a clinic. These results highlight the potential of HIVST in increasing HIV testing rates, while underscoring the importance of developing effective approaches to maximizing linkage to care among those testing positive through HIVST.

Feasibility and acceptability of a pilot, peer-led HIV self-testing intervention in a hyperendemic fishing community in rural Uganda

“…would be willing to link to HIV care if they were found to be HIV-positive. However, our finding of a high linkage to HIV care following HIV self-testing is much higher than previously reported in facility-based HIV self-testing studies [33,34]. Several factors could have contributed to the high linkage to HIV care observed in our study: a) the use of community-based peer-leaders to distribute HIVST kits to fellow men could have motivated men to talk about HIV testing and the need for linkage to HIV care (if HIV-positive) with their male peer-leaders, as has been adduced from prior social network-based studies; [35,36] b) the high coverage of HIV services, including antiretroviral therapy within the targeted fishing community [4] could have acted as a motivator for respondents to seek HIV services as a normative behavior; and c) the presence of two ART-accredited health facilities that served the three fishing communities, located within easy reach of the study population, could have presented more of a motivator than a barrier for respondents to access HIV services.…”

Formative research to inform the development of a peer-led HIV self-testing intervention to improve HIV testing uptake and linkage to HIV care among adolescents, young people and adult men in Kasensero fishing community, Rakai, Uganda: a qualitative study

“…Linkage to HIV care remains a critical challenge across HIVST studies [ 49 , 50 ]. In a recent implementation study of oral and blood-based HIV self-testing and linkage to care among men in rural and peri-urban KwaZulu-Natal, South Africa, Shapiro, van Heerden, Krows, et al [ 49 ] found 32% of HIV-positive men did not link to HIV care after 2 months of their initial HIVST positive result citing lack of time to go to clinic, having to be at work during the hours that the clinic is open, and being concerned about long wait times at the HIV clinic.…”

Preparing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Self-Testing Implementation: Lessons Learned From HIV Self-Testing

“…Initiatives such as but not limited to the Self-Testing AfRica (STAR), the largest HIVST implementation science project to date (44), 4 Youth by Youth crowdsourced HIVST interventions (45,46), and Self-Testing Education and Promotion (STEP) project (28,33), have created a market for HIVST in sub-Saharan Africa. These initiatives combined with other studies around the globe have accelerated access to HIVST by gathering the necessary acceptability, feasibility, and fidelity data, creating an enabling environment with regards to HIVST policies, generating diverse demand through multiple distribution channels, and creating advocacy for additional financing, as well as accelerate market entry for suppliers at affordable and sustainable prices (44,45,(47)(48)(49). Similar initiatives are needed swiftly to gather additional accuracy, acceptability, feasibility, and programmatic data to encourage policy makers, donors, and local health agencies to support for SARS-CoV-2ST implementation and scale up.…”