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The impact of HIV self-testing on recent testing, status knowledge, and linkage to care among female sex workers in Kampala, Uganda: a randomized controlled trial


Author
Ortblad et al.

Publication year
2017

Country

Type of approach
Dual

Type of assistance
Both

Specimen
Oral-fluid

Study population
Key population

Study design
Trials

Sample size
960

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

Methodology
Femal sex worker peer educators each recruited and enrolled 8 eligible participants. Peer educator-participant groups were randomized to one of three study arms: (1) distribution of an HIVST kit, (2) distribution of an HIVST coupon (exchangeable at specified clinics), or (3) referral to standard testing services, all by the peer educator. Participants in the intervention arms received two HIVST kits or coupons, one after enrollment and one three months later. Participants completed baseline, one-month, and four-month assessments. HIV status knowledge was assessed at four months with a perceived conditional cash transfer; participants received ~1 USD if their reported HIV status matched the results of a rapid test.

Summary of findings
Between Oct and Nov 2017, 960 participants were enrolled. Participant age was (median: 28, IQR: 24-32). Relative to the standard arm, recent HIV testing was more common in the HIVST arm at one month (95.2% HIVST vs. 71.5% standard, P< 0.001) and both intervention arms at 4 months (45.9% standard; 59.5% HIVST, P=0.04; 62.3% coupon, P=0.008). There were no significant differences in correct HIV status knowledge across study arms at four months (88.0% standard; 88.1% HIVST, P=0.96; 86.9% coupon, P=0.73). Among those testing positive, there was no difference in linkage to care between HIVST and standard arms. Linkage was lower in the coupon arm compared to the standard arm at both follow-up assessments (one month: 24.1% coupon vs. 64.1% standard, P=0.001; four months: 49.2% coupon vs. 75.0% standard, P=0.02).

Acceptability
n/a

Acceptability details
n

Willingness to pay
n/a

Willingness to pay details
n/a

Sensitivity
0.679

Specificity
0.677

Concordance
n/a

HIV positivity
9.1% (13.4% (39/289) tested positive in the direct HIVST arm, followed by 16.8% (54/321) and 12.3% (39/315) in the standard of care (at 1 month). 9.1% (34/262) tested positive in the direct HIVST arm, followed by 22% (66/297) tested positive in the coupon HIVST arm, and 14.6% (44/301) in the standard of care arm at 4 months.)

Accuracy details
Preliminary data on unassisted HIVST among femal sex workers using oral-fluid HIVST: sensitivity 67.9% (95%CI 54.5-81.4%), specificity 67.7% (95%CI 56.1-79.6%).

Social harm
n/a

Linkage to prevention, care and treatment
70.6% linkage (24/34) in direct HIVST arm, 48.5% (32/66) in coupon HIVST arm, and 75% (33/44) in the standard of care arm.


Study status
Completed