In the Journals Plus

Door-to-door offer of HIV self-testing kits increases knowledge of status

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January 5, 2019

Providing a choice of self-testing during door-to-door HIV testing services increased people’s awareness of their HIV status in Zambia, specifically among men, according to study findings.

“Despite widespread availability of facility-based and community-based HIV testing services, an estimated 30% of all people living with HIV are unaware of their HIV-positive status,” Chama Mulubwa, MPH, of the University of Zambia School of Public Health, and colleagues wrote. “Furthermore, since 2010, the number of global new adult HIV infections has remained stable at around 1.9 million per year. Increasing coverage of HIV prevention services requires novel strategies to deliver HIV testing services and reach individuals who remain unaware of their HIV status.”

According to Mulubwa and colleagues, although coverage of HIV testing in Zambia has increased substantially since 2007, there are still gaps. For example, from 2015 to 2016, 70% of HIV-positive women knew their status compared with only 63% of men. To fill these gaps and reach untested residents of Zambia, a cluster-randomized trial called HPTN 071 (PopART) is ongoing in 21 communities in South Africa and Zambia to estimate the effect on HIV incidence of universal testing and immediate treatment.

For the trial, 66 zones in the communities were randomly assigned to receive either oral HIV self-testing plus routine door-to-door HIV testing services — the HIV self-testing group — or the PopART standard of care of door-to-door HIV testing services alone. According to the study, in HIV self-testing zones, community HIV care providers visited households and offered anyone aged 16 years or older the choice of HIV self-testing or routine door-to-door HIV testing services. Self-test kits were left for partners who were absent during the visits.

Between Feb. 1 and April 30, 2017, community HIV care providers identified 13,267 eligible people in the HIV self-testing group and 13,706 in the standard of care group. Study findings showed that 68% of participants (n = 9,027) in the self-testing group had knowledge of their HIV status, compared with 65% (n = 8,952) in the standard of care group. According to the study, for men, knowledge of HIV status was higher in the HIV self-testing group than in the non-HIV self-testing group. Researchers deduced this was due to increased acceptability of HIV self-testing, compared with standard finger-prick rapid diagnostic test (RDT).

“A 3-month intervention of the addition of HIV self-testing to door-to-door offer of finger-prick RDT had small but significant effects on knowledge of HIV status and uptake of HIV testing services in four communities in Zambia. This effect was seen among men, but also among community residents who previously declined participation in PopART,” the authors wrote.

“Community-based secondary distribution of HIV self-test kits might be an effective strategy to provide HIV testing to reach individuals underserved by HIV-testing services in settings exposed to door-to-door delivery of HIV-testing services. To maximize the effect and reduce costs, any future rollout plan should target services more efficiently to reach men and other populations who are not currently accessing available HIV-testing services.”– by Caitlyn Stulpin

Disclosures: Mulubwa reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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