A pilot trial of the peer-based distribution of HIV self-test kits among fishermen in Bulisa, Uganda

Abstract

Background: HIV self-testing (HIVST) addresses barriers to HIV diagnosis among men, but current approaches to distributing HIVST kits only reach a subset of the men requiring testing.

Methods: We conducted a pilot trial of the secondary distribution of HIVST kits through peer networks in fishing communities of Buliisa district (Uganda). We recruited distributors ("seeds") among male patients of a health facility, and among community members. Seeds were trained in HIVST and asked to distribute up to five kits to their peers ("recruits"). Recruits were referred to the study using a coupon, and asked to return the HIVST kit (used or unused). The accuracy of HIVST was measured against a confirmatory test conducted by a health worker. We conducted audio computer assisted self-interviews to measure the occurrence of adverse events, and evaluate the potential yield of peer-delivered HIVST. We also assessed how seeds and recruits rated their experience with peer-distributed HIVST.

Results: Nineteen seeds offered an HIVST kit to 116 men, and 95 (81.9%) accepted the offer. No recruit reported coercion, but two seeds experienced hostility from recruits or their family members. The sensitivity of peer-distributed HIVST, as interpreted by recruits, was 100%, and its specificity was 92.8%. Among recruits, 29 had never tested (25.8%), and 42 (44.2%) had tested more than a year ago. Three men living with HIV learned their status through peer-distributed HIVST (yield = 1 new diagnosis per 6.3 seeds). Most recruits (85/88) and seeds (19/19) reported that they would recommend HIVST to their friends and family. All seeds stated that they would accept acting as peer distributors again.

Conclusions: This novel peer-based distribution model of HIVST is safe, and has high uptake. It could help reduce the gender gap in HIV testing in under-served fishing communities in Uganda and elsewhere.

Fig 1. Flow chart of study participation and recruitment.

Fig 2. Association between age of the seed and age of the recruits.

Notes: each circle represents one or several seed-recruit pairs. The size of the circle is proportional to the number of pairs. The dotted line represents equality between the ages of seeds and ages of recruits. Thus, for dots that lie below that line, the seed was older than the recruit. The red line represents the Lowess fit to the cloud of points.

Fig 3. Education attainment by HIV status of the seeds.

Fig 4. Seed to recruit relationship by the HIV status of the seeds.

Fig 5. Peer-distributed HIVST outcomes, by mode of enrollment of the seed.

Notes: The graph represents the distribution of recruits by mode of enrollment of the seed on the x-axis, and the distribution of recruits by HIVST outcome on the y-axis. The differences in outcomes between recruits from seeds enrolled at ART services vs. non ART services were significant at the p<0.05.