Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment

Mathenjwa, Thulile; Hy, Kim; Zuma, Thembelihle; Shahmanesh, Maryam; Seeley, Janet; Matthews, Philippa; Wyke, Sally; McGrath, Nuala; Sartorius, Benn; Yapa, H. Manisha; Adeagbo, Oluwafemi; Blandford, Ann; Dobra, Adrian; Bärnighausen, Till; Tanser, Frank

doi:10.1186/s12889-019-7277-0

Cited by 18 publications

(39 citation statements)

References 30 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study protocols for the AHRI’s population‐based HIV testing platform and HITS intervention were approved by the Biomedical Research Ethics Committee of the University of KwaZulu‐Natal (BE290/16 and BFC398/16) [34]. Permission for the trial was obtained from the KwaZulu‐Natal Department of Health, South Africa.…”

Section: Methodsmentioning

confidence: 99%

Home‐Based Intervention to Test and Start (HITS): a community‐randomized controlled trial to increase HIV testing uptake among men in rural South Africa

Tanser

Kim

Mathenjwa

et al. 2021

J. Intern. AIDS Soc.

View full text Add to dashboard Cite

Introduction The uptake of HIV testing and linkage to care remains low among men, contributing to high HIV incidence in women in South Africa. We conducted the “Home‐Based Intervention to Test and Start” (HITS) in a 2x2 factorial cluster randomized controlled trial in one of the World’s largest ongoing HIV cohorts in rural South Africa aimed at enhancing both intrinsic and extrinsic motivations for HIV testing. Methods Between February and December 2018, in the uMkhanyakude district of KwaZulu‐Natal, we randomly assigned 45 communities (clusters) (n = 13,838 residents) to one of the four arms: (i) financial incentives for home‐based HIV testing and linkage to care (R50 [$3] food voucher each); (ii) male‐targeted HIV‐specific decision support application, called EPIC‐HIV; (iii) both financial incentives and male‐targeted HIV‐specific decision support application and (iv) standard of care (SoC). EPIC‐HIV was developed to encourage and serve as an intrinsic motivator for HIV testing and linkage to care, and individually offered to men via a tablet device. Financial incentives were offered to both men and women. Here we report the effect of the interventions on uptake of home‐based HIV testing among men. Intention‐to‐treat (ITT) analysis was performed using modified Poisson regression with adjustment for clustering of standard errors at the cluster levels. Results Among all 13,838 men ≥ 15 years living in the 45 communities, the overall population coverage during a single round of home‐based HIV testing was 20.7%. The uptake of HIV testing was 27.5% (683/2481) in the financial incentives arm, 17.1% (433/2534) in the EPIC‐HIV arm, 26.8% (568/2120) in the arm receiving both interventions and 17.8% in the SoC arm. The probability of HIV testing increased substantially by 55% in the financial incentives arm (risk ratio (RR)=1.55, 95% CI: 1.31 to 1.82, p < 0.001) and 51% in the arm receiving both interventions (RR = 1.51, 95% CI: 1.21 to 1.87 p < 0.001), compared to men in the SoC arm. The probability of HIV testing did not significantly differ in the EPIC‐HIV arm (RR = 0.96, 95% CI: 0.76 to 1.20, p = 0.70). Conclusions The provision of a small financial incentive acted as a powerful extrinsic motivator substantially increasing the uptake of home‐based HIV testing among men in rural South Africa. In contrast, the counselling and testing application which was designed to encourage and serve as an intrinsic motivator to test for HIV did not increase the uptake of home‐based testing.

show abstract

Section: Methodsmentioning

confidence: 99%

Home‐Based Intervention to Test and Start (HITS): a community‐randomized controlled trial to increase HIV testing uptake among men in rural South Africa

Tanser

Kim

Mathenjwa

et al. 2021

J. Intern. AIDS Soc.

View full text Add to dashboard Cite

show abstract

“…It is therefore vital that novel methods are found to engage men and younger populations to facilitate increased and more rapid linkage to treatment and care. In response to these findings, a 2 × 2 factorial cluster-randomized community-based trial, Home-Based Intervention to Test and Start (HITS) [22], was initiated in the AHRI population cohort [22,23]. The HITS trial aims to establish the impact of small once-off financial incentives and a male-targeted HIV-specific decision support application on improving the uptake of HIV testing and linkage to care among men, with the ultimate aim of reducing population-level HIV incidence in (particularly young) women.…”

Section: Key Insights From the Anrs 12249 Cluster-randomized Trialmentioning

confidence: 99%

Opportunities and Challenges in HIV Treatment as Prevention Research: Results from the ANRS 12249 Cluster-Randomized Trial and Associated Population Cohort

et al. 2020

View full text Add to dashboard Cite

Purpose of Review The ANRS 12249 treatment as prevention (TasP) trial investigated the impact of a universal test and treat (UTT) approach on reducing HIV incidence in one of the regions of the world most severely affected by the HIV epidemic-KwaZulu-Natal, South Africa. We summarize key findings from this trial as well as recent findings from controlled studies conducted in the linked population cohort quantifying the long-term effects of expanding ART on directly measured HIV incidence (2004-2017). Recent Findings The ANRS TasP trial did not-and could not-demonstrate a reduction in HIV incidence, because the offer of UTT in the intervention communities did not increase ART coverage and population viral suppression compared to the standard of care in the control communities. Ten controlled studies from the linked population cohort-including several quasiexperimental study designs-exploit heterogeneity in ART exposure to show a consistent and substantial impact of expanding provision of ART and population viral suppression on reduction in HIV incidence at the couple, household, community, and population levels. Summary In this setting, all of the evidence from large, population-based studies (inclusive of the ANRS TasP trial) is remarkably coherent and consistent-i.e., higher ART coverage and population viral suppression were repeatedly associated with clear, measurable decreases in HIV incidence. Thus, the expanded provision of ART has plausibly contributed in a major way toward the dramatic 43% decline in population-level HIV incidence in this typical rural African population. The outcome of the ANRS TasP trial constitutes a powerful null finding with important insights for overcoming implementation challenges in the population delivery of ART. This finding does not imply lack of ART effectiveness in blocking onward transmission of HIV nor its inability to reduce HIV incidence. Rather, it demonstrates that large increases in ART coverage over current levels will require health systems innovations to attract people living with HIV in early stages of the disease to participate in HIV treatment. Such innovations and new approaches are required for the true potential of UTT to be realized.

show abstract

“…The HITS trial was designed to assess the effectiveness of financial micro-incentives (R50[$3] food vouchers) and/ or a SDT informed decision support application (EPIC-HIV1) delivered on tablet to increase the uptake of home-based HIV testing in men. Detailed information about HITS and EPIC-HIV development are described elsewhere (Mathenjwa et al, 2019).…”

Section: Trial Overviewmentioning

confidence: 99%

“…A consistent theme, across different settings, is that the social costs of testing and accessing care outweigh the perceived health benefits, particularly for young men (Adams & Zamberia, 2017;Adeagbo et al, 2018;Adeagbo et al, 2019;Chikovore et al, 2016;HSRC, 2018;Iwuji et al, 2018). Structural barriers such as a lack of male-friendly HIV services and privacy, facing anticipated stigma in the clinic, restrictive clinic hours and long waiting times as well as fear of an "HIV identity" and its perceived incompatibility with masculinity, are some factors impeding men's effective uptake of HIV testing and care services (Bor et al, 2015;Chikovore et al, 2016;Mathenjwa et al, 2019;Tanser et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…EPIC-HIV contains two different applications: EPIC-HIV1: a self-administered app offered at the point of HIV test to men to help them make an informed choice about testing and, if necessary, whether to engage with care. EPIC-HIV2: a second app offered to men who tested HIV-positive but not linked to care within a month after diagnosis, was to motivate them to initiate antiretroviral therapy (ART) and stay in care (Mathenjwa et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Uptake of HIV testing remains low among men in South Africa. As part of a trial, we assessed the acceptability of a theoretically derived and adapted tablet-based-application (EPIC-HIV1) in rural South Africa. We conducted 20 in-depth interviews with men aged ≥18 years and offered a tablet-based survey to all men aged ≥15 years who received EPIC-HIV1 (Sep-Dec 2018). We conducted a descriptive analysis of the survey and used Self-Determination Theory (SDT) to guide our thematic analysis. A total of 232/307 (75%) completed the survey, 55% of whom were aged 15-24 years. 96%[ CI: 92.8-98.2%; n = 223] found EPIC-HIV1 acceptable and 77% [95% CI: 71.8-82.6%; n = 179] found it user-friendly. 222 [96%] reported that EPIC-HIV1 motivated them to test; 83% (192/232) tested for HIV, of which 33% (64/192) were first time testers. Those who did not consent (n = 40) were more likely to have had an HIV-positive test result. Participants reported that the app boosted their confidence to test. However, they were unsure that the app would help them overcome barriers to test in local clinics. Given reach and usability, an adapted SDT male-tailored app was found to be acceptable and could encourage positive health-seeking behavioural change among men.

show abstract

Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment

Cited by 18 publications

References 30 publications

Home‐Based Intervention to Test and Start (HITS): a community‐randomized controlled trial to increase HIV testing uptake among men in rural South Africa

Home‐Based Intervention to Test and Start (HITS): a community‐randomized controlled trial to increase HIV testing uptake among men in rural South Africa

Opportunities and Challenges in HIV Treatment as Prevention Research: Results from the ANRS 12249 Cluster-Randomized Trial and Associated Population Cohort

Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study

Contact Info

Product

Resources

About