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Randomized Controlled Trial
. 2021 Jul;6(Suppl 4):e004543.
doi: 10.1136/bmjgh-2020-004543.

Does community-based distribution of HIV self-tests increase uptake of HIV testing? Results of pair-matched cluster randomised trial in Zambia

Melissa Neuman  1 , Bernadette Hensen  2 , Alwyn Mwinga  3 , Namwinga Chintu  4   5 , Katherine L Fielding  6   7 , Nixon Handima  3 , Karin Hatzold  5 , Cheryl Johnson  8 , Chama Mulubwa  3 , Mutinta Nalubamba  4 , Eveline Otte Im Kampe  6 , Musonda Simwinga  3 , Gina Smith  4   5 , Dickson Tsamwa  3 , Elizabeth Lucy Corbett  2   9 , Helen Ayles  2   3
Affiliations
Randomized Controlled Trial

Does community-based distribution of HIV self-tests increase uptake of HIV testing? Results of pair-matched cluster randomised trial in Zambia

Melissa Neuman et al. BMJ Glob Health. 2021 Jul.

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).

Keywords: Cluster randomised trial; HIV; community-based survey; public health; screening.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
CONSORT diagram showing flow of study participants. CONSORT, Consolidated Standards of Reporting Trials; HIVST, HIV self-testing.
See this image and copyright information in PMC

References

    1. UNAIDS . Accelerating towards 90–90–90. Geneva: UNAIDS, 2018.
    1. UNAIDS . Global AIDS update 2019 — communities at the centre. Geneva: UNAIDS, 2019.
    1. ICAP . Zambia population-based HIV impact assessment. Karachi: ICAP, 2016.
    1. World Health Organization . Consolidated guidelines on HIV testing services. Geneva: World Health Organization, 2015. - PubMed
    1. World Health Organization, UNAIDS . Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva: World Health Organization, 2007.

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