Secondary Distribution of HIV Self-Tests: an Innovative Strategy for Promoting Male Partner Testing and Reducing Risk
More than half of HIV-infected individuals in sub-Saharan Africa (SSA) are unaware of their serostatus. Increasing awareness of serostatus is the first of the UNAIDS “90-90-90” targets and a critical step in ensuring the success of HIV treatment as prevention. Despite wider availability of facility- and community-based HIV testing and counseling services in sub-Saharan Africa, there remains an urgent need to identify more effective ways to increase HIV testing among high-risk individuals and their sexual partners. Novel interventions that can promote testing, identify HIV-infected persons, and facilitate improved sexual decision-making could substantially reduce the number of new HIV infections in the region.
HIV self-testing (HIVST) is a promising approach for increasing knowledge of HIV status. HIVST offers increased convenience and privacy, with studies showing high acceptability and demand for self-testing across a wide range of populations and settings. With the development of simple, oral fluid-based tests, a number of countries in SSA are developing policies to implement and support self-testing. The proposed study tests a ‘secondary distribution’ HIVST intervention that our team has piloted. It seeks to increase HIV testing and reduce high-risk sexual behaviors through ‘secondary distribution’ of HIV self-tests, whereby an individual is given multiple self-tests and encouraged to distribute them in their sexual networks.
The Jikinge (Kiswahili for “protect yourself”) project is a mixed-methods, cluster randomized clinical trial among approximately 2,000 high-risk HIV negative women in the Nyanza region of western Kenya. The study seeks to determine the effectiveness of secondary distribution of HIV self-tests in promoting male partner testing, facilitating safer sexual behaviors, and ultimately reducing incident HIV infections among women. Beginning in June 2017, women in intervention clusters will be offered a regular supply of HIV self-tests along with counseling on how to distribute and use the tests with their current and potential partners. Concurrently, women in control clusters will be offered referral vouchers that encourage HIV testing at a local clinic and encouraged to distribute those vouchers to their partners. Over an 18-month follow-up period, the study will examine outcomes of HIV incidence, identification of HIV positive partners, and unprotected sexual encounters with partners whose status is positive or unknown. A cost-effectiveness analysis will also be conducted to guide policy decisions regarding optimal distribution strategies for HIV self-tests in Kenya and other countries.