HIV self-testing among young women in rural South Africa: A randomized controlled trial comparing clinic-based HIV testing to the choice of either clinic testing or HIV self-testing with secondary distribution to peers and partners

Pettifor, Audrey; Lippman, Sheri A.; Kimaru, Linda; Haber, Noah; Mayakayaka, Zola; Selin, Amanda; Twine, Rhian; Gilmore, Hailey; Westreich, Daniel; Mdaka, Brian; Wagner, Ryan G.; Gómez-Olivé, Xavier; Tollman, Stephen; Kahn, Kathleen

doi:10.1016/j.eclinm.2020.100327

Cited by 63 publications

(75 citation statements)

References 19 publications

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“…Our study adds to the literature [38] which demonstrates that self-testing is safe and accurate in increasing knowledge of HIV status among women; there were no reported adverse events associated with self-testing and AGYW were able to perform the self-test and accurately interpret their results. More importantly, there were no invalid/indeterminate test results reported, in contrast to a study conducted in a Kenyan general adult population where a number of participants had an invalid test result (18.6% in men and 7.7% in women) [15].…”

Section: Discussionmentioning

confidence: 57%

Preferred HIV Testing Modalities Among Adolescent Girls and Young Women in Kenya

Inwani

Chhun

Agot

et al. 2021

Journal of Adolescent Health

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To improve testing coverage, it is imperative to determine adolescent girls and young women (AGYW) preferences about HIV testing modality and where they prefer receiving services. Methods: Participants were enrolled between May 2017 and April 2018 from three sites in Homa Bay County, Nyanza region, western Kenya. We explored two recruitment approaches (homebased vs. mobile-event based) and three HIV testing options (oral self-test, staff-administered, or referral to health facility). Exact logistic regression compared yield of newly diagnosed HIV and high-risk HIV-negatives from the recruitment and testing option strategies. Results: A total of 1,198 participants were enrolled, 1,046 (87.3%) at home and 152 (12.7%) at mobile events. Most participants (928, 77.5%) chose staff-aided testing either at home or at a mobile event; 268 (22.4%) chose self-testing; and only 2 (.2%) chose facility referral. Prevalence of newly diagnosed HIV-positives was 2.7% (32/1,198) and 36.8% (429/1,166) of HIV-negative AGYW were identified as high risk. We identified more newly diagnosed HIV infection among AGYW recruited at mobile events than at home (OR ¼ 3.11; 95% CI: 1.33e6.74; p ¼ .02). High-risk status was related to neither recruitment strategy nor testing modality. Older age was associated with increased odds of selecting an oral self-test (OR ¼ 1.85; 95% CI: 1.06e3.22). Conclusions: More than one-third of AGYW were at elevated risk of HIV infection, and those unaware of their HIV infection were more likely to be identified at a mobile outreach. Though selftesting was not the dominant preferred strategy, self-tests were performed accurately and with high confidence. These findings can help inform efficient identification of undiagnosed HIV infection and high risk for seroconversion among AGYW in similar settings.

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Section: Discussionmentioning

confidence: 57%

Preferred HIV Testing Modalities Among Adolescent Girls and Young Women in Kenya

Inwani

Chhun

Agot

et al. 2021

Journal of Adolescent Health

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“…Interventional studies have focused on evaluating the impact of implementation strategies on HIV-ST uptake or on overall HIV testing rates. The most commonly studied strategy was distribution of self-testing kits through community members, volunteers or peers [44,61,67,74,78,85,124,125,140,146,151,159,162,194] or intimate partners (usually female) [28,47,49,68,144,147,152,156,161,165,166]. All except Tun et al [74] used direct distribution of kits to users.…”

Section: Acceptabilitymentioning

confidence: 99%

“…Tun et al [74], instead, asked peers in Nigeria to invite target users to visit a center to claim and use an HIV-ST kit. The other approaches for increasing uptake were distribution via online platforms [58,66,84,87,149,157,158,160,167], HIV-ST information or promotion campaigns [38,67,79,150,153,155,168], and offering HIV-ST after contact with health services (e.g., PreP, pharmacy visits, HIV testing) [25,127,141,143,145,147,154,159,164]. Many studies did not have controls that allowed for proper assessment of impact on HIV testing rates (Fig 4).…”

Section: Acceptabilitymentioning

confidence: 99%

“…In quasi-experimental studies, there was high uptake (�80%) after direct distribution by peers [43,78,146,151] or partners [28,144,152]. Nearly all randomized trials [28, 47,124,144,146,147,156], except for one study in Zimbabwe [67], showed significant positive effects on overall HIV testing rates in the interventions arms. Also, Choko et al [152] noted that in Malawi, distribution via partners with financial incentives can improve actual clinic follow-up by male partners.…”

Section: Plos Onementioning

confidence: 99%

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Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

et al. 2021

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Introduction HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. Methods We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. Results and discussion Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. Conclusions Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.

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“…In Kenya, HIV-ST offered at ANC increased male partner testing by twelve times ( 20 ). In South Africa, when given a choice between clinic-based HIV testing and HIV oral self-testing, the overwhelming majority of young women chose HIV-ST offering an important opportunity to significantly increase testing rates among young women, their peers and partners ( 21 ). Males are known to have the highest HIV case identification gap worldwide while adolescent girls and young women (AGYW) also account for the majority of new infections.…”

Section: Discussionmentioning

confidence: 99%

High HIV Positivity Rates Following Large-Scale HIV Self-Testing Implementation in Zimbabwe, 2018–2020

Muchedzi¹,

Mpofu

Mudzengerere³

et al. 2021

Front. Public Health

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Introduction: HIV self-testing (HIV-ST) is an innovative strategy to increase HIV case identification. This analysis shares the outcomes of HIV-ST implementation within the Zimbabwe HIV Care and Treatment (ZHCT) project for the period October 2018–March, 2020.Materials and Methods: We extracted HIV-ST data for the period October 2018 to March 2020 from the project database and assessed (1) the proportion of reactive HIV-ST results; (2) the concordance between reactive HIV-ST results against rapid confirmatory HIV tests using Determine™ and Chembio™ in parallel; and (3) the monthly contribution of HIV-ST to total HIV positive individuals identified within project. The Chi-square test was used to assess for statistical differences in HIV positivity between age groups, by sex and district; as well as the difference in HIV positivity between the HIV-ST and index and mobile testing strategies.Findings: Between October 2018 and March 2020, the ZHCT project distributed 11,983 HIV-ST kits; 11,924 (99.8%) were used and 2,616 (21.9%) were reactive. Of the reactive tests, 2,610 (99.8%) were confirmed HIV positive giving a final positivity rate of 21.9%, and a concordance rate of 99.8% between the HIV-ST results and the confirmatory tests. Proportion of reactive results differed by age-groups (p < 0.001); with the 35–49 years having the highest positivity rate of 25.5%. The contribution of HIV-ST to total new positives increased from 10% in October 2018 to 80% at the end of March 2020 (p < 0.001). Positivity rates from HIV-ST were significantly different by age-groups, sex and district (p = 0.04). Additionally, index and mobile testing had a higher positivity rate compared to HIV-ST (p < 0.001).Conclusion: The ZHCT project has successfully scaled up HIV self-testing which contributed significantly to HIV case finding. Countries should consider using the lessons to scale-up the intervention which will contribute in reaching under-served and undiagnosed populations.

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HIV self-testing among young women in rural South Africa: A randomized controlled trial comparing clinic-based HIV testing to the choice of either clinic testing or HIV self-testing with secondary distribution to peers and partners

Cited by 63 publications

References 19 publications

Preferred HIV Testing Modalities Among Adolescent Girls and Young Women in Kenya

Preferred HIV Testing Modalities Among Adolescent Girls and Young Women in Kenya

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

High HIV Positivity Rates Following Large-Scale HIV Self-Testing Implementation in Zimbabwe, 2018–2020

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