Kathryn L. Dovel
SEATTLE — HIV-positive patients who brought home HIV self-test kits to their sexual partners greatly increased testing without disrupting their relationships, according to results from a randomized trial in Malawi. However, self-testing did not improve ART initiation, suggesting it should be coupled with other interventions to link more people to care.
“In the HIV epidemic, we struggle to get sexual partners tested, and this is an important gap because sexual partners of HIV-positive clients are at higher risk of infection,” Kathryn L. Dovel, PhD, MPH, an adjunct assistant professor at the University of California, Los Angeles, said during a press conference. “Actually, it’s one of the most high-risk groups in the epidemic.”
Dovel added that most of the sexual partners of HIV-positive patients in sub-Saharan Africa are men, a group that is unlikely to engage in health services.
Dovel and colleagues conducted the trial at three district hospitals in Malawi between March 2018 and January 2019. The study included 365 clients with HIV aged 15 years or older whose partners’ HIV status was unknown. The participants, who had no history of interpersonal violence with their partners, were randomly assigned in a 1:2.5 ratio to either bring home standard partner referral slips asking their sexual partners to come to the facility and get tested, or deliver an oral self-test kit to their sexual partners that could be used in the privacy of their own home.
“What we found was that HIV self-testing largely works,” Dovel said.
Testing uptake was "dramatically higher" in the self-testing arm, according to the Dovel — 73% compared with 27% in the referral group. Dovel said HIV self-testing tripled the number of sexual partners who got tested (from 23% to 66%), and it more than doubled the number of sexual partners newly identified as HIV positive (from 6% to 15%).
Dovel said both HIV-positive clients and their sexual partners were happy with self-testing, and there was no increase in adverse events such as psychological intimate partner violence or breakups.
However, although testing improved, ART initiation did not, Dovel said. For example, only 23% of sexual partners who were identified through self-testing as having HIV actually initiated ART after 6 months, compared with 75% of those in the standard-of-care arm.
Dovel said this finding shows that HIV self-testing “is not a magic bullet.”
“In order to engage partners throughout the treatment continuum, self-testing has to be coupled with innovative, differentiated models for ART delivery,” she said.
Results from a larger study in Malawi involving almost 2,400 women showed that partner-delivered HIV self-test kits in addition to financial incentives improved linkage to care and prevention services among male partners. Dovel noted that the larger study included antenatal clients whose HIV status was unknown — a different population than the HIV-positive participants in her research team's study. – by John Schoen
Choko AT, et al. PLoS Medicine. 2018;doi:10.1371/journal.pmed.1002719.
Dovel K, et al. Abstract 93. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.
Disclosures: Dovel reports no relevant financial disclosures.