Article Text
Abstract
Objectives Ending HIV by 2030 is a global priority. Achieving this requires alternative HIV testing strategies, such as HIV self-testing (HIVST) to reach all individuals with HIV testing services (HTS). We present the results of a trial evaluating the impact of community-based distribution of HIVST in community and facility settings on the uptake of HTS in rural and urban Zambia.
Design Pair-matched cluster randomised trial.
Methods In catchment areas of government health facilities, OraQuick HIVST kits were distributed by community-based distributors (CBDs) over 12 months in 2016–2017. Within matched pairs, clusters were randomised to receive the HIVST intervention or standard of care (SOC). Individuals aged ≥16 years were eligible for HIVST. Within communities, CBDs offered HIVST in high traffic areas, door to door and at healthcare facilities. The primary outcome was self-reported recent testing within the previous 12 months measured using a population-based survey.
Results In six intervention clusters (population 148 541), 60 CBDs distributed 65 585 HIVST kits. A recent test was reported by 66% (1622/2465) in the intervention arm compared with 60% (1456/2429) in SOC arm (adjusted risk ratio 1.08, 95% CI 0.94 to 1.24; p=0.15). Uptake of the HIVST intervention was low: 24% of respondents in the intervention arm (585/2493) used an HIVST kit in the previous 12 months. No social harms were identified during implementation.
Conclusion Despite distributing a large number of HIVST kits, we found no evidence that this community-based HIVST distribution intervention increased HTS uptake. Other models of HIVST distribution, including secondary distribution and community-designed distribution models, provide alternative strategies to reach target populations.
Trial registration number ClinicalTrials.gov Registry (NCT02793804).
- HIV
- Cluster randomised trial
- public health
- screening
- community-based survey
Data availability statement
Data are available in a public, open access repository. Data are available upon request. Data available upon request from datacompass.lshtm.ac.uk. The protocol is available from hivstar.lshtm.ac.uk.
This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (CC BY NC 3.0 IGO), which permits use, distribution,and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.Disclaimer: The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.
Statistics from Altmetric.com
Data availability statement
Data are available in a public, open access repository. Data are available upon request. Data available upon request from datacompass.lshtm.ac.uk. The protocol is available from hivstar.lshtm.ac.uk.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Handling editor Seye Abimbola
Twitter @ccasejohn
Contributors HA, ELC and KH conceptualised the study. HA, BH, KLF, ELC, NC, NH, CJ, AM, MNa, MNe, MS and DT coauthored the study protocol. NC, MNa and GS led intervention implementation. NH and DT led data collection. BH, MNe and KLF conducted statistical analysis. MNe wrote the first draft of the manuscript. All authors contributed to writing and editing the manuscript, and have reviewed and approved this version.
Funding This work is supported by Unitaid (grant number: PO#8477-0-600). ELC is supported by the Wellcome Trust (grant number: WT091769).
Competing interests The authors have no competing interests. The contents in this article arethose of the authors and do not necessarily reflect the view of the WorldHealth Organization.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.