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Accelerating progress towards the first 90 among men: a trial of the peer-based distribution of HIV self-test kits in Bulisa, Uganda


Author
Nanfuka et al.

Publication year
2017

Country

Type of approach
Dual

Type of assistance
Directly assisted

Specimen
Oral-fluid

Study population
General population

Study design
Feasibility/acceptability

Sample size
115

UNAIDS HIV prevalence (2017)
7.1 [6.6 - 7.7]

Methodology
Male patients at a TASO-facility were recruited as seed participants. Seeds were introduced to HIV self-testing and asked if they would distribute HIVST kits to peers who had not recently tested. Seeds were given up to 5 HIVST kits (OraQuick HIV Self Test kits), instructions and scripts addressing questions their peers may ask about HIVST. Recruited peers were referred to the study using a coupon with a unique number, and were asked to return the HIVST kit (used or unused). Audio computer-assisted self-interviews with seeds and recruits were conducted to measure a) the occurrence of adverse events (e.g., coercion) and b) the uptake of HIVST kits. The accuracy of HIVST was measured against a confirmatory HIV test conducted by a health worker.

Summary of findings
19 seeds offered an HIVST kit to 115 men. 95/115 (82.6%) accepted the HIVST kit. Of these, 29/95 (26%) had never been tested and 42/95 (44.2%) had tested > 1 year ago. According to confirmatory testing, HIV prevalence was 4.3% among recruits (4/94). Compared to this standard national algorithm, the sensitivity of the OraQuick HIV Self Test was 100%. Three men living with HIV learned of their infection through HIVST (yield = 1 new diagnosis per 6.3 seeds). The specificity of HIVST was 93.3% (88/94). The 6 false positives were due to a faint grey line appearing on the test location of the OraQuick HIV Self Test. No recruit reported coercion, but one seed experienced hostility from family members of a recruit.

Acceptability
0.826

Acceptability details
83% (95/115) accepted HIVST when offered.

Willingness to pay
n/a

Willingness to pay details
n/a

Sensitivity
1

Specificity
0.933

Concordance
n/a

HIV positivity
4.3% (4/94)

Accuracy details
OraQuick HIV Self Test: 100% sensitivity and 93% specificity. This was measured based on agreement with confirmatory test performed by health worker. Six false positives were due to a faint grey line appearing on the test location of the OraQuick kit.

Social harm
No recruit reported coercion, but one seed experienced hostility from family members of a recruit.

Linkage to prevention, care and treatment
n/a


Study status
Completed