Examining the Use of HIV Self-Testing to Support PrEP Delivery: a Systematic Literature Review

Kiptinness, Catherine; Kuo, Alexandra P.; Reedy, Adriana M; Johnson, Cheryl; Ngure, Kenneth; Wagner, Anjuli D.; Ortblad, Katrina F

doi:10.1007/s11904-022-00617-x

Cited by 21 publications

(18 citation statements)

References 30 publications

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“…To continue to expand models of community-delivered PrEP services, reliance on HIV selftesting results obtained by clients themselves should be considered to increase efficiencies in PrEP service delivery at facilities and pharmacies and also support new models of PrEP service delivery, such as online PrEP delivery. 39,40 This study has limitations that should be considered. First, we had a small sample of standardized client actors, resulting in few client actor pharmacy PrEP visits.…”

Section: Discussionmentioning

confidence: 98%

The Fidelity of a Pharmacy-Based Oral HIV Pre-Exposure Prophylaxis Delivery Model in Kenya

Omollo

Asewe

Mogere

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: HIV pre-exposure prophylaxis (PrEP) delivery at private pharmacies is a promising new differentiated service delivery model that may address barriers to PrEP delivery at public health care facilities. We measured the fidelity of this model (ie, delivery as intended) in a pilot study in Kenya. Setting: Five private, retail pharmacies in Kisumu and Thika Counties. Methods: Trained pharmacy providers delivered PrEP services, including identifying eligible clients, counseling on HIV risk, assessing PrEP safety, testing for HIV, and dispensing PrEP. Pharmacy clients completed surveys that assessed the fidelity of the services received after each visit. Standardized client actors (ie, mystery shoppers) were trained on 4 different case scripts, then made unannounced pharmacy visits, and then completed a 40-item checklist that assessed the fidelity and quality of service delivery components. Results: From November 2020 to December 2021, 287 clients initiated and 159 (55%) refilled PrEP. At initiation, most clients were counseled on PrEP adherence (99%, 284 of 287) and potential side effects (97%, 279 of 287) and all received provider-assisted HIV self-testing before PrEP dispensing (findings consistent across refill visits). Nine standardized client actors completed 15 pharmacy visits. At each visit, most actors were asked about their behaviors associated with HIV risk (80%, 12/15) and all were counseled on PrEP safety and side effects. All actors reported that pharmacy providers treated them with respect. Conclusions: In this first pilot study of pharmacy-delivered PrEP services in Africa, the fidelity of service delivery was high, suggesting that trained providers at private pharmacies can deliver quality PrEP services.

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Section: Discussionmentioning

confidence: 98%

The Fidelity of a Pharmacy-Based Oral HIV Pre-Exposure Prophylaxis Delivery Model in Kenya

Omollo

Asewe

Mogere

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Access to HIVST is expanding in many settings in sub-Saharan Africa to increase reach and identify new HIV diagnoses [49]. Incorporating HIVST into service delivery for HIV prevention [50][51][52][53], including for PrEP continuation [54], has the potential to lower barriers and increase efficiency by reducing the number of visits to a health facility. Moreover, oral HIVST could increase choices for persons who may not wish to have blood-based testing with a provider.…”

Section: Discussionmentioning

confidence: 99%

Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda

Koss,

Ayieko,

Kabami

et al. 2023

Aids

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Objective: HIV prevention service delivery models that offer product choices, and the option to change preferences over time, may increase prevention coverage. Outpatient departments in sub-Saharan Africa diagnose a high proportion of new HIV infections, but are an understudied entry point to biomedical prevention. Design: Individually randomized trial of dynamic choice HIV prevention (DCP) intervention vs. standard-of-care (SOC) among individuals with current/anticipated HIV exposure risk at outpatient departments in rural Kenya and Uganda (SEARCH; NCT04810650). Methods: Our DCP intervention included 1) product choice (oral pre-exposure prophylaxis [PrEP] or post-exposure prophylaxis [PEP]) with option to switch over time, 2) HIV provider- or self-testing, 3) service location choice (community vs. clinic-based), 4) provider training on patient-centered care. Primary outcome was proportion of follow-up covered by PrEP/PEP over 48 weeks assessed via self-report. Results: We enrolled 403 participants (61% women; median 27 years, IQR 22,37). In the DCP arm, 86% ever chose PrEP, 15% ever chose PEP over 48 weeks; selection of HIV self-testing increased from 26% to 51% and of out-of-facility visits from 8% to 52%. Among 376/403 (93%) with outcomes ascertained, time covered by PrEP/PEP was higher in DCP (47.5%) vs. SOC (18.3%); difference=29.2% (95%CI:22.7–35.7%; p < 0.001). Effects were similar among women and men (28.2% and 31.0% higher coverage in DCP, respectively) and larger during periods of self-reported HIV risk (DCP 64.9% vs. SOC 26.3%; difference=38.6%; 95%CI:31.0–46.2%; p < 0.001). Conclusion: A dynamic choice HIV prevention intervention resulted in two-fold greater time covered by biomedical prevention products compared to standard-of-care in general outpatient departments in eastern Africa.

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“…Self-testing has consistently been shown to increase access to and uptake on testing overall and can greater uptake of both prevention and treatment services (8,9). While the use of self-testing is increasingly available and well-accepted (10,11), it is important to understand the experiences and views in the context of COVID-19 We conducted a survey targeting policy makers, researchers, and implementers to generate a global understanding of policies and experiences with SARS-CoV-2 AgRDTs for self-testing. Our findings informed the development of WHO guidelines and serve as a future reference point as global policies and practices continue to evolve.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 self-testing: Countries accelerating policies ahead of WHO guidelines during pandemics: A Global Survey

Sakala,

Johnson,

Chirombo

et al. 2023

Preprint

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Introduction The widespread use of antigen-detection rapid diagnostic tests (Ag-RDTs) has revolutionized SARS-CoV-2 (COVID-19) testing, particularly through the option of self-testing. The full extent of Ag-RDT utilization for self-testing, however, remains largely unexplored. To inform the development of WHO guidance on COVID-19 self-testing, we conducted a cross-sectional survey to gather the views and experiences of policy makers, researchers, and implementers worldwide. Methods The survey was shared through professional networks via email and social media, encouraging onward sharing. We used closed and open-ended questions related to policy and program information concerning the regulation, availability, target population, indications, implementation, benefits, and challenges of COVID-19 self-testing (C19ST). We defined self-testing as tests performed and interpreted by an untrained individual, often at home. Descriptive summaries, cross-tabulations, and proportions were used to calculate outcomes at the global level and by WHO region and World Bank income classifications. Results Between 01 and 11 February 2022, 844 individuals from 139 countries responded to the survey, with 45% reporting affiliation with governments and 47% operating at the national level. 504 respondents from 101 countries reported policies supporting C19ST for a range of use cases, including symptomatic and asymptomatic populations. More respondents from low-and-middle-income countries (LMICs) than high-income countries (HICs) reported a lack of an C19ST policy (61 vs 11 countries) and low population-level reach of C19ST. Respondents with C19ST experience perceived that the tests were mostly acceptable to target populations, provided significant benefits, and highlighted several key challenges to be addressed for increased success. Reported costs varied widely, ranging from specific programmes enabling free access to certain users and others with high costs via the private sector. Conclusion Based on the survey responses, systems for the regulatory review, policy development and implementation of C19STappeared to be much more common in HIC when compared to LIC in early 2022, though most respondents indicated self-testing was available to some extent (101 out of 139 countries) in their country. Addressing such global inequities is critical for ensuring access to innovative and impactful interventions in the context of a public health emergency of international concern. The challenges and opportunities highlighted by survey respondents could be valuable to consider as future testing strategies are being set for outbreak-prone diseases.

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Examining the Use of HIV Self-Testing to Support PrEP Delivery: a Systematic Literature Review

Cited by 21 publications

References 30 publications

The Fidelity of a Pharmacy-Based Oral HIV Pre-Exposure Prophylaxis Delivery Model in Kenya

The Fidelity of a Pharmacy-Based Oral HIV Pre-Exposure Prophylaxis Delivery Model in Kenya

Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda

COVID-19 self-testing: Countries accelerating policies ahead of WHO guidelines during pandemics: A Global Survey

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