Methods to Encourage HIV Testing Uptake

Day 2 of IAS2015, I attended a very full lunch poster discussion session entitled HIV Testing: The Gateway for Everything.

Sheri Lippman presented two posters. The first presented results from a cluster randomized controlled trial comparing the ‘one man can’ campaign in South Africa which aimed to engage men into testing through community mobilization. Community mobilization was found to be associated with higher testing uptake, though not equally for all CM domains. The main three domains which had the greatest impact were consciousness, concerns and collective action.

Sheri’s second presentation was on a pilot study examining feasibility and acceptability of self-testing in transgender women in San Francisco. 50 HIV-ve trans women were provided home HIV test kits and asked to utilized the tests once a month for three months, behavioral data was also collected at baseline and three months. 96% of study cohort had multiple recent partnerships and 80% had engaged in sex work, so as with other transgender communities, a pretty high risk population. Most found the test easy to use and would recommend to their friends (>90%), 68% would use the test again. The main reasons provided for not using again were around gaining access to counseling services that facility-based testing provided, and most participants had tested with a partner or a friend. A marketing strategy which provided two home-based tests aimed at testing with a partner could be an efficacious method for targeting this hard-to-reach population.

Laura Derksen from the London School of Economics presenting results from a cluster-randomized trial examining methods to reduce stigma in a community based setting in Malawi. 122 Malawi villages were targeting (60 intervention villages and 62 control) which reach two thirds of the target 15-49yrold population. In the control villages information was provided on the benefits of ARV including prolonging life and reversal of AIDS. While in the intervention villages, in addition to the control information, information regarding reduced likelihood of transmission in partnerships where the HIV+ve partner properly adhered to ARV was also propagated. The overall concept being that if they could reduce stigma, by showing that individuals who tested were in fact safer sexual partners then rates of testing would improve. The percent of the population having testing for HIV post-exposure was found to be  60% higher in the intervention arm compared to the control arm, and this was consistent for both genders.

Perhaps the most relevant to the Australian setting was a poster presented by David Katz, which examined self-testing as a method to increase overall testing frequency among high-risk MSM in Seattle. 230 HIV-ve MSM were randomized to have access to free HIV self-tests versus standard HIV testing for 15 months. The primary endpoint was the comparison of HIV testing frequency, secondary endpoints included non-inferiority in regards to behavioral markers of HIV risk acquisition. The mean number of test in the self-testing arm was 5.3 (4.7-6.0) compared to 3.6 (3.2-4.0) in the control arm, which was statistically significant (p<0.0001). Non-inferiority bounds were met for risk acquisition, which included difference in frequency of bacterial STI diagnosis at 15 months, likelihood of non-concordant anal intercourse at 3 months, and number of male non-concordant partners. However confidence intervals were wide for the secondary endpoints and the study not really adequately power to examine these associations.  

And finally the last two posters were presented by Sue Napierala Mavedzenge and Pius Tih Muffih respectively. Sue presented results of a feasibility study which examined the reliability of self-testing in both rural and urban settings in Zimbabwe. There was high sensitivity and specificity of interpreting self-test kits in both rural and urban settings, however slightly lower sensitivity in the rural setting, which was likely a result of lower literacy in this group. Some practical issues to encourage interpretation of the test (such as increased window size) were discussed.  Pius Tih Muffih provided the results of a very interesting study which examined integrating partner notification into Option B+ in Cameroon. Results looked promising with 823 women testing positive providing information on 840 partners of which 693 were notified, of whom 421 were tested for HIV and 139 new HIV+ve cases identified and linked to care. They had not observed any backlash in terms of violence to women as a result of the notification but this was highlighted as an issue which needs to be carefully monitored.