Providing Kenyan women attending prenatal or postpartum health care visits with HIV self-testing kits raised the rates of partner and couples testing to more than 90%, according to a report published online in PLOS Medicine.
HIV testing remains underused in many parts of sub-Saharan Africa, particularly among men, for reasons including social stigma, fear of poor prognosis, lack of awareness of HIV risk, fear that their results would be disclosed, inconvenience, and transportation costs. To assess one strategy for improving male testing rates, researchers performed a study at a hospital and two clinics in urban and suburban Kisumu, Kenya, where the HIV prevalence is approximately 20% among adult residents.
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The trial involved 600 women aged 18-39 years (mean age, 24 years) who were seeking either prenatal or postpartum health care and agreed to participate. They were randomly assigned to receive either a few HIV self-test kits plus counseling regarding HIV testing (intervention group) or counseling alone (control group) and followed for 3 months. A total of 95% of the women – 284 in the intervention group and 286 in the control group – completed the study, said Harsha Thirumurthy, PhD, of the department of health policy and management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, and his associates.
At follow-up, 258 (90.8%) of the women in the intervention group reported that their partners had been tested for HIV, compared with 148 (51.7%) of the control group. This significant difference persisted across all subgroups of patients, regardless of study site and whether or not partners said they had been tested during the preceding year. “This result is encouraging since it suggests that the strategy of giving multiple self-tests to women can effectively increase access to HIV testing in hard-to-reach populations such as men who do not test regularly,” the investigators said (PLOS Med. 2016 Nov 8. doi: 10.1371/journal.pmed.1002166).
In three-fourths of the cases where male partners were tested for HIV, both members of the couple were tested together. This is beneficial because it helps women learn their partners’ HIV status, and because couples who test together are “more likely to adopt a range of HIV prevention and care behaviors,” Dr. Thirumurthy and his associates wrote.
Approximately one-third of the women who were eligible for this study declined to participate, often because they feared that their partners would become violent if offered an HIV self-test. Even women who did participate reported a high rate (27%) of partner violence at baseline. It is encouraging that none of the study participants reported any such incidents in response to the HIV testing, the investigators added.
The International Initiative for Impact Evaluation funded the study. Dr. Thirumurthy and his associates reported having no relevant financial disclosures.