Using Assisted Partner Services for HIV Testing and the Treatment of Males and Their Female Sexual Partners: Protocol for an Implementation Science Study

Abstract

Background Despite the effective scale-up of HIV testing and treatment programs, only 75% of people living with HIV (PLWH) globally know their status, and this rate is lower among men. This highlights the importance of implementing HIV testing and linkage interventions with a high uptake in this population. In a cluster randomized controlled trial conducted in Kenya between 2013 and 2015, we found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH safely reached more HIV-exposed individuals with HIV testing compared with client referral alone. However, more data are needed to evaluate APS implementation in a real-world setting. Objective This study aims to evaluate the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. Methods Our study team from the University of Washington and PATH is integrating APS into 31 health facilities in Western Kenya. We are enrolling females newly diagnosed with HIV (index clients) who consent to receiving APS, their male sexual partners, and female sexual partners of male sexual partners who tested HIV positive. Female index clients and sexual partners testing HIV positive will be followed up at 6 weeks, 6 months, and 12 months postenrollment to assess linkage to care, antiretroviral therapy initiation, and HIV viral load suppression. We will evaluate the acceptability, fidelity, and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and subcounty-level policy makers responsible for HTS. Facility health staff providing HTS and APS, in addition to staff working with the study project team, will also be interviewed. We will also conduct direct observations of facility infrastructure and clinical procedures and extract data from the facilities and county and national databases. Results As of March 2020, we have recruited 1724 female index clients, 3201 male partners, and 1585 female partners. We have completed study recruitment as well as 6-week (2936/2973, 98.75%), 6-month (1596/1641, 97.25%), and 12-month (725/797, 90.9%) follow-up visits. Preliminary analyses show that facilities scaling up APS identify approximately 12-18 new HIV-positive males for every 100 men contacted and tested. We are currently completing the remaining follow-up interviews and incorporating an HIV self-testing component into the study in response to the COVID-19 pandemic. Conclusions The results will help bridge the gap between clinical research findings and real-world practice and provide guidance regarding optimal strategies for APS integration into routine HIV service delivery. International Registered Report Identifier (IRRID) DERR1-10.2196/27262

“It is a process” – a qualitative evaluation of provider acceptability of HIV assisted partner services in western Kenya: experiences, challenges, and facilitators

“…This study was nested within the APS scale-up study, a larger ongoing implementation science study (R01AI134130) [ 14 ] that aimed to scale-up APS in Kisumu and Homa Bay, two counties with the highest HIV prevalence (17.5%, 19.6%, separately) in Kenya [ 1 ]. In this study, HTS providers ask women who tested HIV positive to identify their male sexual partners, provide contact information of partners, and choose one of the three referral methods (contract referral, provider referral and dual referral) after providing adequate information on all the choices.…”

“…However, neither examined acceptability of APS to the service providers and challenges of delivering APS from the providers’ standpoint. As part of a larger ongoing implementation science study [ 14 ] which aimed to determine the effectiveness, feasibility, implementation fidelity, integration, and cost of APS when integrated in existing HIV service delivery in western Kenya, we qualitatively evaluated the acceptability of APS from the perspective of HIV testing services (HTS) providers. We explored their experience of providing APS, the barriers and the facilitators, and how contextual factors influenced their experience.…”

Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study

“…This microcosting analysis was conducted within in the aPS scale-up project (NIAID R01AI134130), a collaborative implementation science study between the Ministry of Health (MOH) National AIDS and STI Control Program (NASCOP), PATH-Kenya and University of Washington, conducted in 31 health facilities in Kisumu and Homa Bay counties in western Kenya [ 14 ]. Details of the aPS scale-up project and its implementation procedures have been published [ 14 ].…”

“…This microcosting analysis was conducted within in the aPS scale-up project (NIAID R01AI134130), a collaborative implementation science study between the Ministry of Health (MOH) National AIDS and STI Control Program (NASCOP), PATH-Kenya and University of Washington, conducted in 31 health facilities in Kisumu and Homa Bay counties in western Kenya [ 14 ]. Details of the aPS scale-up project and its implementation procedures have been published [ 14 ]. The overall goal of the project was to implement and evaluate the effectiveness of aPS when integrated within routine HTS, and assess implementation outcomes including acceptability, demand, integration, implementation fidelity, and costs.…”

“…The aPS scale-up project focused on evaluating aPS as a strategy for increasing HIV testing among men [ 14 ]. Though aPS is offered to both male and female clients receiving HTS in Kenya, this project deliberately targeted adolescent girls and women and their partners to address challenges in finding men who are difficult to mobilize through other interventions and may increase the burden of HIV through risky sexual behavior if not tested and treated Briefly, female clients testing HIV-positive at participating facilities (female index clients) received information on aPS and were screened for eligibility by healthcare workers.…”