April 18, 2016
Self-testing is emerging as a promising approach to increasing HIV testing rates among men in sub-Saharan Africa. In a new study led by Harsha Thirumurthy, PhD, of the UNC Gillings School of Global Public Health, researchers analyzed whether providing multiple self-testing kits to women who are at high risk of HIV acquisition could, in turn, promote testing among their male partners and facilitate safer sexual decision making overall.
The full article, titled “Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study,” was published online April 8 by The Lancet HIV. Two experts in the field further discuss the implications of the study in an editorial commentary, also published online April 8 by The Lancet HIV.
Thirumurthy is an associate professor of health policy and management at UNC Gillings and a faculty fellow at the Carolina Population Center. He wrote the paper with co-authors including Suzanne Maman, PhD, associate professor, and Sam Masters, MPH, doctoral student, both in the Department of Health Policy and Management at the Gillings School.
The study that Thirumurthy and colleagues conducted is one of the very first in Africa to explore an intervention that seeks to promote HIV testing by distributing self-tests through social and sexual networks. In the study, the researchers recruited HIV-negative women between 18 and 39 years old at two sites in Kisumu, Kenya – an urban setting where HIV prevalence is nearly 20 percent. One site was a healthy facility with antenatal and post-partum clinics; the other was a drop-in center for female sex workers.
The site selection intentionally targeted key populations. There are currently well-developed services for the prevention of mother-to-child HIV transmission, but male partners of these mothers have remained underserved. Additionally, female sex workers represent a community where HIV testing is vital, and a large gap exists between ideal and actual testing practices.
At both sites, recruited participants were instructed on the use of oral fluid-based rapid HIV tests. The health facility participants were given three testing kits each, while participants at the drop-in sex worker clinic were given five tests. The researchers interviewed participants at the time of enrollment and over the next three months to determine how the self-tests were used.
Of the 280 total study participants, 265 completed follow-up interviews. Outcomes from those interviews showed that almost all the women with primary sex partners distributed testing kits to their partners, and 81 percent of the sex workers gave out more than one test to commercial sex clients.
When primary sex partners received tests, couples tested together in more than half the cases. Positive results were found in four percent of tests distributed by participants in antenatal care, two percent of tests distributed by women in post-partum care, and 14 percent of tests distributed by female sex workers.
Providing self-tests to women also seemed to facilitate safer sexual decision-making. After distributing self-tests to their male partners, female participants reported having sexual intercourse with 62 percent of partners who tested HIV-negative, but only 18 percent of partners who tested HIV-positive. When male partners received HIV-positive test results, condoms were used in 100 percent of the subsequent intercourse events. Comparatively, condoms were used in only 44 percent of intercourse events that took place after HIV-negative results.
Based on the study results, the researchers concluded that providing multiple HIV self-tests to women at high risk of infection is a promising way to promote HIV testing among male sexual partners. This novel strategy warrants further consideration as countries in sub-Saharan Africa develop self-testing policies and programs.
This research was funded by the Bill & Melinda Gates Foundation.