Real-world impact of integrating HIV assisted partner services into 31 facilities in Kenya: a single-arm, hybrid type 2 implementation-effectiveness study

Naughton, Brienna; Lagat, Harison; Otieno, George; Katz, David A.; Wamuti, Beatrice; Masyuko, Sarah; Bosire, Rose; Mugambi, Mary; Paladhi, Unmesha Roy; Weiner, Bryan J.; Kariithi, Edward; Farquhar, Carey

doi:10.1016/s2214-109x(23)00153-5

Cited by 11 publications

(11 citation statements)

References 29 publications

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“…[47][48][49] Scale-up of effective ICT interventions could lead to substantial public health benefits. [50][51][52][53] The trial will also add to the literature on CQI as implementation strategy for potentially addressing facility-level implementation challenges 54 and evaluate cost-effectiveness of the approach which was encouraged in a recent study. 55 This has implications on implementing ICT both in Malawi and for other countries in SSA.…”

Section: Discussionmentioning

confidence: 99%

Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

Tembo,

Mollan,

Simon

et al. 2024

BMJ Open

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IntroductionIndex case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes.Methods and analysisThe study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested.Ethics and disseminationThe Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberNCT05343390.

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Section: Discussionmentioning

confidence: 99%

Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

Tembo,

Mollan,

Simon

et al. 2024

BMJ Open

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“…Building on the previous implementation science study also allowed this study to be representative of real-world results and, therefore, increases generalizability. Limitations include that before the initiation of the study, our team conducted a large-scale implementation study of Standard APS in the same setting with 31 study sites, which was very successful in ramping up HIV testing, new diagnosis of HIV and linkage to care [5,16]. Due to this success and the team's extensive experience in conducting APS prior to our trial, there was little room for improvement in these outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The APS-HIVST Study was developed as an extension of the APS Scale-up Study [5,16]. We compared the effect of offering HIVST as a testing option (APS+HIVST) to only routine provider-based testing (Standard APS) for partners of index clients identified via APS to estimate the effect of HIVST on partner testing, first-time testing, new HIV diagnoses and linkage to care.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of HIV self‐testing when offered within assisted partner services in Western Kenya (APS‐HIVST Study): a cluster randomized controlled trial

Roy Paladhi,

Katz,

Otieno

et al. 2024

J Int AIDS Soc.

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IntroductionAssisted partner services (APS) is an effective strategy for increasing HIV testing, new diagnosis, and linkage to care among sexual partners of people living with HIV (PLWH). APS can be resource intensive as it requires community tracing to locate each partner named and offer them testing. There is limited evidence for the effectiveness of offering HIV self‐testing (HIVST) as an option for partner testing within APS.MethodsWe conducted a cluster randomized controlled trial comparing provider‐delivered HIV testing (Standard APS) versus offering partners the option of provider‐delivered testing or HIVST (APS+HIVST) at 24 health facilities in Western Kenya. Facilities were randomized 1:1 and we conducted intent‐to‐treat analyses using Poisson generalized linear mixed models to estimate intervention impact on HIV testing, new HIV diagnoses, and linkage to care. All models accounted for clustering at the clinic level and new diagnoses and linkage models were adjusted for individual‐level age, sex, and income a priori.ResultsFrom March to December 2021, 755 index clients received APS and named 5054 unique partners. Among these, 1408 partners reporting a prior HIV diagnosis were not eligible for HIV testing and were excluded from analyses. Of the remaining 3646 partners, 96.9% were successfully contacted for APS and tested for HIV: 2111 (97.9%) of 2157 in the APS+HIVST arm and 1422 (95.5%) of 1489 in the Standard APS arm. In the APS+HIVST arm, 84.6% (1785/2111) tested via HIVST and 15.4% (326/2111) received provider‐delivered testing. Overall, 16.7% of the 3533 who tested were newly diagnosed with HIV (APS+HIVST = 357/2111 [16.9%]; Standard APS = 232/1422 [16.3%]). Of the 589 partners who were newly diagnosed, 90.7% were linked to care (APS+HIVST = 309/357 [86.6%]; Standard APS = 225/232 [97.0%]). There were no significant differences between the two arms in HIV testing (relative risk [RR]: 1.02, 95% CI: 0.96–1.10), new HIV diagnoses (adjusted RR [aRR]: 1.03, 95% CI: 0.76–1.39) or linkage to care (aRR: 0.88, 95% CI: 0.74–1.06).ConclusionsThere were no differences between APS+HIVST and Standard APS, demonstrating that integrating HIVST into APS continues to be an effective strategy for identifying PLWH by successfully reaching and HIV testing >95% of elicited partners, newly diagnosing with HIV one in six of those tested, >90% of whom were linked to care.Clinical Trial NumberNCT04774835

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“…Although sub-Saharan Africa has made notable strides in addressing HIV [ 11 , 12 ]; VAPN has been suggested as an additional cost-effective strategy [ 13 , 14 ] to reach the estimated ~ 2.4 million people [ 15 – 17 ] living with undiagnosed HIV infections in the region and to achieve the UNAIDS 95–95-95 targets by 2030 1 [ 18 , 19 ]. Recent studies in sub-Saharan Africa often focus on client-level experiences and highlight that VAPN is largely acceptable, feasible, and effective at tracing partners exposed to HIV [ 6 , 9 , 10 , 20 – 24 ]. VAPN has also been found to be appropriate for targeting hard-to-reach populations (e.g., men) for testing [ 10 , 25 – 27 ] and is often reported to have insignificant adverse events (e.g., intimate partner violence [IPV]) [ 1 , 6 , 10 , 22 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

“The targets…are driving the agenda and that probably needs to change”: stakeholder perspectives on HIV partner notification in sub-Saharan Africa

McGowan,

Bärnighausen,

Berner-Rodoreda

et al. 2024

BMC Public Health

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Background Voluntary assisted partner notification (VAPN) in HIV contact tracing is a globally recommended strategy to identify persons who have been exposed to HIV and link them to HIV testing and follow-up. However, there is little understanding about how VAPN is experienced by stakeholders in sub-Saharan African (SSA) contexts. We conducted a multi-level and multi-national qualitative analysis evaluating stakeholder perspectives surrounding VAPN implementation to inform the development of future VAPN policies. Method We conducted in-depth interviews (IDIs) with VAPN stakeholders at global (n = 5), national (n = 6), and community level (n = 4) across a total of seven SSA countries. Eligible participants were ≥ 18 years old and had experience developing, implementing, or overseeing VAPN policies in SSA. We sought to understand stakeholder’s perspectives on policy development, implementation, and perceived outcomes (barriers and facilitators). Interviews were audio recorded, transcribed, and analyzed thematically using a combination of inductive and deductive approaches. Results Between December 2019 and October 2020 we conducted 15 IDIs. While participants agreed that VAPN resulted in a high yield of people newly diagnosed with HIV; they noted numerous barriers surrounding VAPN implementation across global, national, and community levels, the majority of which were identified at community level. Barriers at global and national level included high target setting, contradictory laws, and limited independent research disenfranchising the experiences of implementing partners. The barriers identified at community level included client-level challenges (e.g., access to healthcare facilities and fear of adverse events); healthcare worker challenges (e.g., high workloads); limited data infrastructure; and cultural/gender norms that hindered women from engaging in HIV testing and VAPN services. In response to these barriers, participants shared implementation facilitators to sustain ethical implementation of VAPN services (e.g., contact tracing methods) and increase its yield (e.g., HIV self-testing integrated with VAPN services). Conclusion Overall, stakeholders perceived VAPN implementation to encounter barriers across all implementation levels (global to community). Future VAPN policies should be designed around the barriers and facilitators identified by SSA stakeholders to maximize the implementation of (ethical) HIV VAPN services and increase its impact in sub-Saharan African settings.

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Real-world impact of integrating HIV assisted partner services into 31 facilities in Kenya: a single-arm, hybrid type 2 implementation-effectiveness study

Cited by 11 publications

References 29 publications

Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

Effectiveness of HIV self‐testing when offered within assisted partner services in Western Kenya (APS‐HIVST Study): a cluster randomized controlled trial

“The targets…are driving the agenda and that probably needs to change”: stakeholder perspectives on HIV partner notification in sub-Saharan Africa

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