RT Journal Article
SR Electronic
T1 Does community-based distribution of HIV self-tests increase uptake of HIV testing? Results of pair-matched cluster randomised trial in Zambia
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e004543
DO 10.1136/bmjgh-2020-004543
VO 6
IS Suppl 4
A1 Melissa Neuman
A1 Bernadette Hensen
A1 Alwyn Mwinga
A1 Namwinga Chintu
A1 Katherine L Fielding
A1 Nixon Handima
A1 Karin Hatzold
A1 Cheryl Johnson
A1 Chama Mulubwa
A1 Mutinta Nalubamba
A1 Eveline Otte im Kampe
A1 Musonda Simwinga
A1 Gina Smith
A1 Dickson Tsamwa
A1 Elizabeth Lucy Corbett
A1 Helen Ayles
YR 2021
UL http://gh.bmj.com/content/6/Suppl_4/e004543.abstract
AB 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).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.