Impact of HIV Self-Test Distribution to Male Partners of ANC Clients: Results of a Randomized Controlled Trial in Kenya

Gichangi, Anthony; Wambua, Jonesmus; Mutwiwa, Stephen; Njogu, Rosemary; Bazant, Eva; Wamicwe, Joyce; Wafula, Rose; Vrana, Caroline J.; Stevens, Danielle; Mudany, Mildred; Korte, Jeffrey E.

doi:10.1097/qai.0000000000001838

Cited by 81 publications

(101 citation statements)

References 13 publications

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“…When asked about the three HIV testing modalities, concerns were raised by all stakeholders about potential social harms, most commonly relationship conflict and stigmatization. Most trials, however, evaluating antenatal partner testing approaches found few or no social harms . One exception was a passive partner notification evaluation that found the majority of intimate partner violence (IPV) was reported among couples who had received a positive HIV result during couples testing (4/6) .…”

Section: Discussionmentioning

confidence: 99%

“…Stakeholders identified potential implementation challenges for each HIV testing modality. Although evaluation trials have demonstrated the effectiveness of these male partner HIV testing approaches in antenatal settings , implementation research with cost‐effectiveness analysis would be helpful to guide countries when considering partner testing approaches. While cost‐effectiveness studies in the general adult population have been promising , evidence of cost‐effectiveness in antenatal settings is still needed.…”

Section: Discussionmentioning

confidence: 99%

“…Several evidence‐based practices increase male partner HIV testing in antenatal settings in SSA, including partner notification , home‐based testing and secondary distribution of self‐test kits . These approaches target male partners of HIV‐positive and HIV‐negative pregnant and postpartum women.…”

Section: Introductionmentioning

confidence: 99%

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Perspectives on HIV partner notification, partner HIV self‐testing and partner home‐based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia

et al. 2019

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Introduction HIV testing male partners of pregnant and postpartum women can lead to improved health outcomes for women, partners and infants. However, in sub‐Saharan Africa, few male partners get HIV tested during their partner's pregnancy in spite of several promising approaches to increase partner testing uptake. We assessed stakeholders’ views and preferences of partner notification, home‐based testing and secondary distribution of self‐test kits to understand whether offering choices for partner HIV testing may increase acceptability. Methods Interviewers conducted semi‐structured interviews with HIV‐negative (N = 39) and HIV‐positive (N = 41) pregnant/postpartum women, male partners of HIV‐negative (N = 14) and HIV‐positive (N = 14) pregnant/postpartum women, healthcare workers (N = 19) and policymakers (N = 16) in Malawi and Zambia. Interviews covered views of each partner testing approach and preferred approaches; healthcare workers were also asked about perceptions of a choice‐based approach. Interviews were transcribed, translated and analysed to compare perspectives across country and participant types. Results Most participants within each stakeholder group considered all three partner testing strategies acceptable. Relationship conflict was discussed as a potential adverse consequence for each approach. For partner notification, additional barriers included women losing letters, being fearful to give partners letters, being unable to read and men refusing to come to the clinic. For home‐based testing, additional barriers included lack of privacy or confidentiality and fear of experiencing community‐level HIV stigma. For HIV self‐test kits, additional barriers included lack of counselling, false results and poor linkage to care. Preferred male partner testing options varied. Participants preferred partner notification due to their respect for clinical authority, home‐based testing due to their desire to prioritize convenience and clinical authority, and self‐test kits due to their desire to prioritize confidentiality. Less than half of couples interviewed selected the same preferred male partner testing option as their partner. Most healthcare workers felt the choice‐based approach would be acceptable and feasible, but noted implementation challenges in personnel, resources or space. Conclusions Most stakeholders considered different approaches to partner HIV testing to be acceptable, but concerns were raised about each. A choice‐based approach may allow women to select their preferred method of partner testing; however, implementation challenges need to be addressed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Perspectives on HIV partner notification, partner HIV self‐testing and partner home‐based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia

et al. 2019

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“…Implementing aPS together with other HIV testing strategies that are proven to be effective, such as the secondary distribution of HIV self‐tests to partners of female index participants, may further increase HIV case finding in hard‐to‐reach populations . While immediate aPS may reduce the testing gap among men and those in rural/peri‐urban areas, access to services needs to be improved to ensure effective treatment and HIV viral suppression.…”

Section: Discussionmentioning

confidence: 99%

Index participant characteristics and HIV assisted partner services efficacy in Kenya: results of a cluster randomized trial

et al. 2019

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Introduction We have previously demonstrated that assisted partner services (aPS) increases HIV testing and case finding among partners of persons living with HIV (PLHIV) in a cluster randomized trial in Kenya. However, the efficacy of aPS may vary across populations. In this analysis, we explore differences in aPS efficacy by characteristics of index participants. Methods Eighteen HIV testing sites were randomized to immediate versus 6‐week delayed aPS. Participants were PLHIV (or index participants) and their sexual partners. Partners of index participants were contacted for HIV testing and linked to care if HIV positive. Primary outcomes were the number of partners per index participant who: 1) tested for HIV, 2) tested HIV positive and 3) enrolled in HIV care. We used generalized estimating equations to assess differences in aPS efficacy by region, testing location, gender, age and knowledge of HIV status. Results From 2013 to 2015, the study enrolled 1119 index participants, 625 of whom were in the immediate group. These index participants named 1286 sexual partners. Immediate aPS was more efficacious than delayed aPS in promoting HIV testing among partners in high compared to low HIV prevalence regions (Nyanza incidence rate ratio (IRR) 7.2; 95% confidence interval (CI) 5.4, 9.6 vs. Nairobi/Central IRR 3.4 95% CI 2.3, 4.8). Higher rates of partner HIV testing were also observed for index participants in rural/peri‐urban compared to urban sites (IRR 6.6; 95% CI 4.5, 9.6 vs. IRR 3.5 95% CI 2.5, 5.0 respectively), for female versus male index participants (IRR 5.8 95% CI 4.2, 7.9 vs. IRR 3.7; 95% CI 2.4, 5.8 respectively) and for newly diagnosed versus known HIV‐positive index participants (IRR 6.0 95% CI 4.2, 8.7 vs. IRR 3.3; 95% CI 2.0, 7.7 respectively). Providing aPS to female versus male index participants also had a significantly higher HIV case finding rate (IRR 9.1; 95% CI 4.0, 20.9 vs. IRR 3.2 95% CI 1.7, 6.0 respectively.) Conclusions While it is known that aPS promotes increases in HIV testing and case finding, this is the first study to demonstrate significant differences in aPS efficacy across characteristics of the index participant. Understanding these differences and their drivers will be critical as aPS is brought to scale in order to ensure all PLHIV have access to these services.

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“…However, male testing rates lag far behind (UNAIDS, 2018). Emerging evidence, from our studies and others, suggests that testing rates among male partners may significantly increase with the availability of HIV oral self-testing kits brought home from the clinic by their pregnant female partners both in Kenya (Gichangi et al, 2018;Masters et al, 2016) and Uganda (Korte et al, n.d.). The promising results of studies testing this delivery model have supported recent decisions by Ministries of Health in both Kenya and Uganda to incorporate HIV oral self-testing kits into their national HIV strategies.…”

Section: Introductionmentioning

confidence: 64%

HIV testing preferences among pregnant women attending antenatal care and their male partners: a discrete choice experiment in Uganda

Korte

Strauss

Bâ

et al. 2019

African Journal of AIDS Research

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Impact of HIV Self-Test Distribution to Male Partners of ANC Clients: Results of a Randomized Controlled Trial in Kenya

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 81 publications

References 13 publications

Perspectives on HIV partner notification, partner HIV self‐testing and partner home‐based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia

Perspectives on HIV partner notification, partner HIV self‐testing and partner home‐based HIV testing by pregnant and postpartum women in antenatal settings: a qualitative analysis in Malawi and Zambia

Index participant characteristics and HIV assisted partner services efficacy in Kenya: results of a cluster randomized trial

HIV testing preferences among pregnant women attending antenatal care and their male partners: a discrete choice experiment in Uganda

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