Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study

Carballo‐Diéguez, Alex; Giguere, Rebecca; Balán, Iván C.; Brown, William; Dolezal, Curtis; Leu, Cheng-Shiun; Rios, Javier López; Sheinfil, Alan Z.; Frasca, Timothy; Rael, Christine Tagliaferri; Lentz, Cody; Crespo, Raynier; Iribarren, Sarah J.; Torres, Catherine Cruz; Febo, Irma

doi:10.1007/s10461-019-02763-7

Cited by 19 publications

(17 citation statements)

References 33 publications

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“…First, the trial had a cluster-randomised design and was large scale, with 27 government clinics as the unit of randomisation (including a previously unstudied priority patient cohort [index patients]) and ANC clinic attendees. This design is key and differs substantially from previous studies that were relatively small 4 and individually randomised, 5,30,31 or cohort studies, 6,32 which have a huge potential for contamination and bias. Second, the interventions were delivered via a pragmatic design by Ministry of Health personnel, as would be the case during routine implementation (including kit supply chain, distribution, and documentation).…”

Section: Discussionmentioning

confidence: 97%

Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial

Choko

Fielding

Johnson

et al. 2021

The Lancet Global Health

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Background Secondary distribution of HIV self-testing (HIVST) kits by patients attending clinic services to their partners could improve the rate of HIV diagnosis. We aimed to investigate whether secondary administration of HIVST kits, with or without an additional financial incentive, via women receiving antenatal care (ANC) or via people newly diagnosed with HIV (ie, index patients) could improve the proportion of male partners tested or the number of people newly diagnosed with HIV. MethodsWe did a three-arm, open-label, pragmatic, cluster-randomised trial of 27 health centres (clusters), eligible if they were a government primary health centre providing ANC, HIV testing, and ART services, across four districts of Malawi. We recruited women (aged ≥18 years) attending their first ANC visit and whose male partner was available, not already taking ART, and not already tested for HIV during this pregnancy (ANC cohort), and people (aged ≥18 years) with newly diagnosed HIV during routine clinic HIV testing who had at least one sexual contact not already known to be HIV-positive (index cohort). Centres were randomly assigned (1:1:1), using a public selection of computer-generated random allocations, to enhanced standard of care (including an invitation for partners to attend HIV testing services), HIVST only, or HIVST plus a US$10 financial incentive for retesting. The primary outcome for the ANC cohort was the proportion of male partners reportedly tested, as ascertained by interview with women in this cohort at day 28. The primary outcome for the index cohort was the geometric mean number of new HIV-positive people identified per facility within 28 days of enrolment, as measured by observed HIV test results. Cluster-level summaries compared intervention with standard of care by intention to treat. This trial is registered with ClinicalTrials. gov, NCT03705611. FindingsBetween Sept 8, 2018, and May 2, 2019, nine clusters were assigned to each trial arm, resulting in 4544 eligible women in the ANC cohort (1447 [31•8%] in the standard care group, 1465 [32•2%] in the HIVST only group, and 1632 [35•9%] in HIVST plus financial incentive group) and 708 eligible patients in the index cohort (234 [33•1%] in the standard care group, 169 [23•9%] in the HIVST only group, and 305 [42•9%] in the HIVST plus financial incentive group). 4461 (98•2%) of 4544 eligible women in the ANC cohort and 645 (91•1%) of 708 eligible patients in the index cohort were recruited, of whom 3378 (75•7%) in the ANC cohort and 439 (68•1%) in the index cohort were interviewed after 28 days. In the ANC cohort, the mean proportion of reported partner testing per cluster was 35•0% (SD 10•0) in the standard care group, 73•0% in HIVST only group (13•1, adjusted risk ratio [RR] 1•71, 95% CI 1•48-1•98; p<0•0001), and 65•2% in the HIVST plus financial incentive group (11•6, adjusted RR 1•62, 1•45-1•81; p<0•0001). In the index cohort, the geometric mean number of new HIV-positive sexual partners per cluster was 1•35 (SD 1•62) for the standard care group, 1•91 (...

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Section: Discussionmentioning

confidence: 97%

Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial

Choko

Fielding

Johnson

et al. 2021

The Lancet Global Health

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“…As noted in Carballo-Dieguez's primary outcome paper, (17) seven participants (5%) reported having any difficulties performing the test; one (1%) reported difficulties interpreting the results, four (3%) reported calling the hotline number shown in the test kit, and one (1%) reported contacting study personnel due to problems using the test. The most commonly reported difficulties were the test kits getting damaged or not working properly.…”

Section: Benefits Of Hivstmentioning

confidence: 93%

Using an HIV Self-test Kit to Test a Partner: Attitudes and Preferences Among High-Risk Populations

et al. 2020

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For those most at risk of contracting HIV, new strategies for preventing transmission and increasing testing are needed. As part of a multi-site, randomized, controlled trial (RCT), we explored attitudes and preferences among 272 HIV-negative men who have sex with men and HIVnegative transgender women using an HIV self-testing (HIVST) kit to test partners. Less than one quarter had previously self-tested with HIVST kits (21.7%) and few had partner-tested (4.8%). Most preferred gum swab (96%) over fingerprick tests (69%), but would prefer a blood test if it gave results for other sexually transmitted infections (STIs) (86%). Five percent reported difficulties performing the test, four percent with storage, and 26% with portability. Ninety-three percent reported likelihood of using HIVST to test partners in future, but only 3% were willing to pay the current price. Efforts to improve HIVST uptake should focus on incorporating testing for other STIs, reducing test kit size, and reducing cost.

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“…While several HIVST studies, including implementation science projects, have been conducted in Africa and other countries [23], our systematic review of HIV testing interventions literature in the Caribbean [37] revealed that only two studies have focused on HIVST in the Caribbean region [38,39]. Since the publication of this systematic review, results from a recent study in Puerto Rico revealed that the use of HIVST kits to screen sexual partners was acceptable and helped identify partners of positive HIV status among men who have sex with men (MSM) and transgender women, including sex workers, though some participants faced negative partner reactions when broaching the topic of HIVST [40][41][42][43][44].…”

Section: Introductionmentioning

confidence: 99%

Local and national stakeholders’ perceptions towards implementing and scaling up HIV self-testing and secondary distribution of HIV self-testing by Option B+ patients as an assisted partner service strategy to reach men in Haiti

Conserve

Michel²,

Demes

et al. 2020

PLoS ONE

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HIV self-testing (HIVST), which allows people to test in private, is an innovative testing strategy that has been shown to increase HIV testing among men. Delivering HIVST kits to men via women is one promising assisted partner service strategy. Little research has been conducted on HIVST secondary distribution to men by women living with HIV (WLWH) in the Caribbean and other settings. The purpose of this study was to assess the perspectives of WLWH, their male partners, and healthcare professionals on the perceived advantages and disadvantages of HIVST, and recommendations for implementing HIVST in Haiti, with a focus on secondary distribution of HIVST to men by WLWH. Sixteen key informant interviews and nine focus groups with 44 healthcare workers, 31 Option B+ clients, and 13 men were carried out in Haiti. Key informants were representatives of the Ministry of Health and of a non-governmental agency involved in HIV partner services. Focus group members included program leads and staff members from the HIV care and treatment program, the Option B+ program, the community health service program, and the HIV counseling and testing services from 2 hospitals. Perceived HIVST advantage included an increase in the number of people who would learn their HIV status and start treatment. The perceived disadvantages were lack of support to ensure self-testers initiate treatment, uncertainty about male partner's reaction, risk of violence towards women delivering HIVST kits after receiving an HIVST kit from a woman, and the inability of women to counsel a man in case his selftest result is positive. Recommendations for integrating HIVST and secondary distribution of

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Use of Rapid HIV Self-Test to Screen Potential Sexual Partners: Results of the ISUM Study

Cited by 19 publications

References 33 publications

Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial

Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial

Using an HIV Self-test Kit to Test a Partner: Attitudes and Preferences Among High-Risk Populations

Local and national stakeholders’ perceptions towards implementing and scaling up HIV self-testing and secondary distribution of HIV self-testing by Option B+ patients as an assisted partner service strategy to reach men in Haiti

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