Self-Testing Takes Off in Men When Women Are Given HIV Kits

Pam Harrison

July 31, 2015

VANCOUVER, British Columbia — When women are given HIV self-tests to distribute to their sex partners, men are more likely to get tested and find out their HIV status, according to a pilot project conducted in Kenya.

"We thought that HIV self-testing might be particularly appealing to men because it offers a very private and easy way to learn their HIV status," said Harsha Thirumurthy, PhD, from the University of North Carolina Gillings School of Global Public Health in Chapel Hill.

"The challenge remained that men would have to get ahold of the HIV self-test, so we focused on pregnant and postpartum women seeking services at health facilities, as well as female sex workers receiving HIV prevention services, he told Medscape Medical News. "We figured that these women would be good candidates for distributing HIV self-tests to their male partners."

"Our team was very pleased with the results," he reported when he presented the study results here at the 8th International AIDS Society Conference.

The study involved 280 HIV-uninfected pregnant women, postpartum women, and female sex workers recruited from two sites in the urban setting of Kisumu, Kenya.

The women were taught how to use the OraQuick rapid HIV test (OraSure Technologies), which provides results in 20 minutes, and were given multiple tests, which they were encouraged to distribute to their partners or clients at their discretion.

They were also provided with information on where to seek confirmatory testing and HIV care if a positive result was obtained.

The women were interviewed to assess use and distribution 1, 2, and 3 months after they received the tests. Almost all participants completed the follow-up interviews.

Our team was very pleased with the results.

The investigators found that 192 of the women conducted self-tests, and 709 of the tests were distributed to male sex partners.

Two tests were distributed by 71% of the pregnant women and by 82% of the postpartum women.

Of the sex workers, 81% distributed a test to at least one client. Three tests were distributed by 24% of these women, and four tests were distributed by 56%.

Only about 15% of the distributed test kits did not get used, the investigators note.

Of the women who reported having a primary partner at the time of study enrolment, 93% of the pregnant women and 86% of the postpartum women reported distributing a test to that partner.

Of the tests distributed, 97.5% were used by the person it was given to.

"We expected at the outset that there may be some reluctance on the part of the women to distribute the tests to their male partners," Dr Thirumurthy said.

"But based on their reports to our research assistants, we were thrilled to hear from the women that their male partners were very receptive to self-testing and that, in many cases, the women themselves were present when the males took the test," he explained.

HIV-Positive Test Results

The investigators were also struck by the high proportion of men reported to have tested positive for HIV. Overall, 4.8% of the pregnant women's partners tested positive, as did 3.3% of the postpartum women's partners and 15.3% of the sex workers' clients.

It is important that people understand that just because the OraQuick test is an oral saliva test, "it doesn't mean that there is HIV in one's salvia," Dr Thirumurthy said.

"This is a public health message that has been promoted for some time— that HIV can't be transmitted through kissing or through oral fluids — so we had to make it clear that this is an antibody test and is not detecting HIV itself in the salvia," he explained.

The investigators also made it clear that there is a "window" during which antibodies to HIV cannot be detected. Participants needed to know that a negative test does not necessarily mean that a person is not infected with HIV, Dr Thirumurthy said.

"Our rationale was that having some HIV testing taking place in this population, which doesn't test very often, is still be better than no HIV testing," he pointed out. "I see a lot of potential for this type of approach to be used, not only in settings like the one in Kenya, where we did the study, but outside of Kenya as well."

The outcomes of this study are very interesting and encouraging, said Rachel Baggaley, MD, from the World Health Organization.

"We know that HIV testing access and uptake is much higher among women than among men in many high-prevalence countries, such as Kenya," she told Medscape Medical News. "A key reason for this is that women have more frequent access to health settings, including antenatal care, where HIV testing is routinely offered."

Because men often test late in their HIV infection, they start antiretroviral therapy later, which results in worse treatment outcomes, Dr Baggaley explained.

"Innovative ways to support increasing access to testing by men — such as offering HIV self-test kits to women to share with their partners — seemed to be successful and acceptable in this study," she pointed out.

"WHO encourages countries to explore self-testing approaches to reach the 50% of people with HIV who remain unaware, and to carefully monitor the acceptability and linkage to confirmatory testing and services after self-testing, along with any adverse outcomes," she added.

This study was funded by the Bill and Melinda Gates Foundation. Dr Thirumurthy and Dr Baggaley have disclosed no relevant financial relationships.

8th International AIDS Society (IAS) Conference. Abstract MOACO302LB. Presented July 20, 2015.


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