Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial

Abstract

BackgroundAchieving higher rates of partner HIV testing and couples testing among pregnant and postpartum women in sub-Saharan Africa is essential for the success of combination HIV prevention, including the prevention of mother-to-child transmission. We aimed to determine whether providing multiple HIV self-tests to pregnant and postpartum women for secondary distribution is more effective at promoting partner testing and couples testing than conventional strategies based on invitations to clinic-based testing.Methods and FindingsWe conducted a randomized trial in Kisumu, Kenya, between June 11, 2015, and January 15, 2016. Six hundred antenatal and postpartum women aged 18–39 y were randomized to an HIV self-testing (HIVST) group or a comparison group. Participants in the HIVST group were given two oral-fluid-based HIV test kits, instructed on how to use them, and encouraged to distribute a test kit to their male partner or use both kits for testing as a couple. Participants in the comparison group were given an invitation card for clinic-based HIV testing and encouraged to distribute the card to their male partner, a routine practice in many health clinics. The primary outcome was partner testing within 3 mo of enrollment. Among 570 participants analyzed, partner HIV testing was more likely in the HIVST group (90.8%, 258/284) than the comparison group (51.7%, 148/286; difference = 39.1%, 95% CI 32.4% to 45.8%, p < 0.001). Couples testing was also more likely in the HIVST group than the comparison group (75.4% versus 33.2%, difference = 42.1%, 95% CI 34.7% to 49.6%, p < 0.001). No participants reported intimate partner violence due to HIV testing. This study was limited by self-reported outcomes, a common limitation in many studies involving HIVST due to the private manner in which self-tests are meant to be used.ConclusionsProvision of multiple HIV self-tests to women seeking antenatal and postpartum care was successful in promoting partner testing and couples testing. This approach warrants further consideration as countries develop HIVST policies and seek new ways to increase awareness of HIV status among men and promote couples testing.Trial RegistrationClinicalTrials.gov NCT02386215.

‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

“…If they refused to test for HIV, it is likely that their female partners would think that their refusal is related to their apparent HIV infection or promiscuity status. Nevertheless, our findings reaffirm previous findings from other studies that show that female-delivered HIVST is acceptable and can improve male partner and couples’ HIV testing [2,3,16]. …”

“…These findings suggest a need for alternative HIV-testing approaches that can help to improve HIV-testing rates among men, including female-delivered HIVST. However, while previous studies have reported impressive HIV-testing uptake rates among male partners and couples following female-delivered HIVST [2,3], only one study has explored the strategies that women used to deliver HIVST kits to their male partners [5]. Even then, this study did not document men’s reactions to receiving kits from their female partners.…”

“…A growing body of literature on oral HIV self-testing (HIVST) suggests that it can help to reach people that were not previously targeted by conventional HIV-testing approaches, including male partners and couples [1–3]. A recent systematic review and meta-analysis that examined the effects of HIVST compared with standard HIV-testing services found that HIVST not only doubled uptake of testing among men but also improved HIV-testing frequency particularly among men who have sex with men [4].…”

“…A recent systematic review and meta-analysis that examined the effects of HIVST compared with standard HIV-testing services found that HIVST not only doubled uptake of testing among men but also improved HIV-testing frequency particularly among men who have sex with men [4]. Studies conducted in Kenya [2,3,5] and Malawi [1,6] suggest that distribution of HIVST kits to male partners through female partners is an acceptable approach that provides an opportunity for men to test for HIV without necessarily traveling to a health facility. This may overcome the barriers related to lack of time or traveling to a health facility (which men presume to be a women’s preserve) to test for HIV [7,8].…”

The Case For Family-Centered Differentiated Service Delivery for HIV

“…Furthermore, self-test kits can be used in secondary distribution to test family members who are not home during home-or community-based testing initiatives. 8 Using index client testing through invitation not only of partners but also of children to the facility has also enhanced uptake of HIV testing using a family-centered approach. 9 Expanding index client testing to other members of the community (often within an integrated health screening approach) may further increase uptake of HIV testing services among family units.…”