Secondary Distribution of HIV Self Tests by Female Sex Workers: An Innovative Strategy for Promoting Male Partner Testing and Reducing HIV Risk

Widespread HIV testing and counseling is the essential first step in HIV treatment and prevention efforts. Increasing the uptake of HIV testing among those likely to be HIV-infected is also one of the UNAIDS “90-90-90” targets. However, roughly 55% of HIV-infected individuals in sub-Saharan Africa remain unaware of their serostatus. Men in particular are far less likely to test than women, and there is also a dearth of interventions targeted to high-risk populations in which regular repeat testing can be beneficial. Even less common has been the occurrence of couples testing, which can have a greater health impact than individual testing by resulting in improved sexual decision-making, including increased condom use and increased antiretroviral therapy use to prevent sexual and vertical HIV transmission. HIV self-testing is a promising approach that has the potential to substantially increase access to testing for individuals and couples in a manner that is confidential and empowering for users. Data from across the globe demonstrate high interest in and acceptability of self-testing among a wide range of populations. Although HIV self-testing can be a good alternative for those not engaged in regular repeat testing, little is known about the optimal distribution strategies for facilitating self-test use by the hardest-to-reach individuals. One innovative strategy is ‘secondary distribution’ of HIV self-tests, whereby an individual who is given multiple self-tests can distribute them to sexual partners or to others in their social network. This project will evaluate whether secondary distribution of self-tests by female sex workers in Kenya can be used to fulfill multiple HIV prevention goals, including the promotion of HIV testing among high-risk men and the facilitation of results disclosure, couples testing, and safer sexual decision making. Building on prior evidence on the feasibility of this strategy, this study will conduct a randomized controlled trial in which female sex workers are randomized to receive multiple self-tests or voucher to refer partners to clinic-based HIV testing. Aim 1 tests whether secondary distribution of self-tests by female sex workers results in greater identification of HIV-infected men and safer sexual behaviors. Aim 2 involves conducting in-depth interviews to assess study participants’ experiences distributing self-tests to their sexual partners. Aim 3 will determine the cost-effectiveness of secondary distribution of self-tests by female sex workers. The project will help determine whether HIV self-testing can be useful for furthering multiple HIV prevention goals. It will also provide guidance on optimal distribution strategies for self-tests as countries in sub-Saharan Africa develop HIV self-testing policies and scale up the availability of self-tests.

Principal Investigators: Harsha Thirumurthy, Suzanne Maman

Funding Source: NIH NIMH

Grant Number: R01MH111602

Funding Period: 9/15/2016 - 6/30/2021

Primary Research Area: Population Health

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