Abstract
BackgroundHealth education interventions tailored to suit men have the potential to improve health outcomes for this underserved population. HIV self-testing (HIVST) is a promising approach to overcoming challenges associated with low HIV testing rates among men. The primary objective of this study is to assess the feasibility of conducting a definitive trial to determine the effectiveness of a locally adapted and optimized health education program (HEP) on the uptake of HIVST among men in Kigali, Rwanda.MethodsThis study employs a pilot pragmatic randomized controlled trial to evaluate an HIVST HEP for men. Participants were randomized to the intervention (HEP) arm or to the control arm. In the intervention group, the adapted HEP was administered in addition to routine health education. In the non-intervention group, only routine health education was offered. Participant data was collected first upon recruitment and then after 3 months’ follow-up using interviewer-administered questionnaires.ResultsThere was a 100% response rate at enrollment and no loss to follow-up at exit. There was significant association between the study arm and knowledge of HIVST. Participants in the control arm had a mean knowledge score of 67% compared to 92% among participants in the intervention arm. There was an association between the study arm and HIVST uptake: 67% of the study participants in the intervention arm self-reported HIVST uptake compared to 23% of the participants in the control arm.DiscussionThis pilot study demonstrates the feasibility of a larger trial to assess the effectiveness of an HEP intervention on uptake of HIVST among men. We found preliminary evidence of increased uptake of HIVST in the intervention group.Trial registrationPan African Clinical Trial Registry PACTR201908758321490. Registered on 8 August 2019.
Highlights
Health education interventions tailored to suit men have the potential to improve health outcomes for this underserved population
The Joint United Nations Programme on HIV and AIDS (UNAIDS) reports that in 2018, 21% of people living with HIV/AIDS were unaware of their status [1]
Major success has been reported in the HIV response in Rwanda; available evidence shows a gap between the current situation and the UNAIDS 90-90-90 target for 2020 [3]
Summary
Health education interventions tailored to suit men have the potential to improve health outcomes for this underserved population. Addressing male aversion to HIV testing services (HTS) has remained a priority in Rwanda’s HIV program for more than two decades [4, 5], since a gap in testing rates between men and women has been consistently observed in national surveys conducted in 2005 [6], 2010 [7], 2015 [8], and 2019 [3]. HIV self-testing (HIVST), may potentially benefit men who routinely experience significant breaches to health care anonymity and confidentiality [14,15,16]. A qualitative study conducted on health officials, community health workers, and persons living with HIV in South Africa revealed that people who do not feel “ready” to know their status, who worry about HIV-related stigmas, or who fear dying of AIDS will possibly still be reluctant to be tested, even when self-test kits become available [18]. Provision of health education has been recommended to ensure the proper uptake of HIVST [17, 20, 21]
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