Who Accepts and Who Uses Community-Based Secondary Distribution HIV Self-Testing (HIVST) Kits? Findings From the Intervention Arm of a Cluster-Randomized Trial of HIVST Distribution Nested in Four HPTN 071 (PopART) Communities in Zambia.

Bernadette Hensen,Sian Floyd,Sarah Fidler,Kwame Shanaube,Musonda Simwinga,Virginia Bond,Albertus J Schaap,Alwyn Mwinga,Mwelwa M Phiri,Chama Mulubwa,Chiti Bwalya,Richard Hayes,Helen Ayles

doi:10.1097/qai.0000000000002344

Abstract

Background:HPTN 071 (PopART) was a community-randomized trial of a universal testing-and-treatment intervention on HIV incidence at population level in Zambia and South Africa. In Zambia, a trial of community-based distribution of HIV self-testing (HIVST) kits, including secondary distribution, as an option for HIV-testing was nested within 4 PopART intervention communities. We used data from the intervention arm of the nested trial to measure levels of and factors associated with acceptance and use of secondary distribution HIVST kits.Methods:Community HIV care providers offered the PopART combination HIV-prevention intervention door-to-door, systematically visiting all households and enumerating all household members. From 1 February to 30 April 2017, individuals aged 16 years and older consenting to PopART were offered the option to HIV self-test, if eligible for HIV-testing services. Individuals aged 18 years and older who reported a partner absent during household visits were offered an HIVST kit for secondary distribution to this partner. We used two data sources to measure acceptance and use of secondary distribution HIVST kits.Results:Among 9105 individuals aged 18 years and older consenting to PopART, 9.1% (n = 825) accepted an HIVST kit for secondary distribution. Approximately 55.8% reported that the kit had been used. Women were more likely to accept, and men more likely to use, secondary distribution HIVST kits. Kits were more likely to be used by individuals aged 30+ and who had not participated in a previous round of PopART. Approximately 6.8% had a reactive result.Conclusions:Community-based secondary distribution of HIVST kits reached men absent during community HIV care provider household visits and is a complement to facility- and community-based HIV-testing services, which often miss men.

Highlights

Testing for HIV facilitates entry into the treatment continuum and access to prevention services
Kits were more likely to be used by individuals aged 30+ and who had not participated in a previous round of PopART
We identified 47 individuals who had a result for a secondary distribution HIV self-testing (HIVST) kit recorded, but no household member seen by the CHiP was listed as an intermediary individual

Summary

Introduction

Testing for HIV facilitates entry into the treatment continuum and access to prevention services. Despite its centrality to service access, in 2017, one-quarter of individuals remained unaware of their HIV-positive status globally.[1] In sub-Saharan Africa, men are among those not being reached by HIV services. Of individuals living with HIV, ;58% of boys/men know their HIV-positive status compared. HPTN 071 (PopART) was a communityrandomized trial of a universal testing-and-treatment intervention on HIV incidence at population level in Zambia and South Africa. In. Zambia, a trial of community-based distribution of HIV self-testing (HIVST) kits, including secondary distribution, as an option for HIV-testing was nested within 4 PopART intervention communities. We used data from the intervention arm of the nested trial to measure levels of and factors associated with acceptance and use of secondary distribution HIVST kits

Methods

Results

Discussion

Conclusion