November 16, 2016
Providing pregnant and postpartum women in sub-Saharan Africa with multiple HIV self-tests can make it more likely their male partners will be tested for HIV compared to a standard approach of distributing invitation cards for clinic-based testing, according to a study in PLOS Medicine led by researchers at the University of North Carolina’s Gillings School of Global Public Health.
The study, titled “Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial” was conducted in Kenya and led by Harsha Thirumurthy, PhD, associate professor of health policy and management. Co-authors of the piece include Suzanne Maman, PhD, professor of health behavior, Sam Masters, doctoral student of health policy and management, and Kawango Agot, director of the Impact Research and Development Organization in Kenya.
Thirumurthy says use of testing services in sub-Saharan Africa, particularly by men, is one of the key barriers to meeting targets that UNAIDS has set for HIV prevention. Efforts to encourage pregnant women and postpartum women to refer their partners for testing and to test as a couple, in order to help prevent mother-to-child transmission of HIV, also have had limited success.
“This study shows that when deployed in creative ways, new technologies such as HIV self-tests have considerable potential to overcome longstanding obstacles to HIV testing in populations such as partners of pregnant women in Kenya,” Thirumurthy said. “The convenience and privacy of self-testing made it easier for partners as well as couple to learn their status.”
Thirumurthy and colleagues in Kenya enrolled 600 women into their study; all participants were seeking pregnancy and postpartum care at three facilities in Kisumu County, Kenya. The women enrolled were 18 to 39 years old, had a partner that was not known to be HIV-positive and agreed to participate. Half the women were given two oral fluid-based HIV self-test kits to take home (with instructions on use), and were encouraged to give a test to their male partner or to test with their partner if they felt comfortable. The other 300 women were given invitation cards to give their partner for HIV testing at a clinic. Over the following three months, the researchers followed up with women to determine if their partners had self-tested or visited a clinic to test for HIV.
In the group that received HIV self-tests, 90.8 percent of partners were reported to have tested within three months of enrollment in the study. In the comparison group, 51.7 percent of partners were reported to have visited a clinic for HIV testing.
Thirumurthy says that the study provides insight for some important next steps.
“In high-prevalence settings, there should be consideration of providing multiple HIV self-tests to pregnant women who are interested in offering a test to their partner,” he said. “Interventions that seek to increase linkage of partners to appropriate HIV care are also needed.”