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Secondary Distribution of HIV Self-tests: an Innovative Strategy for Promoting Partner Testing and Reducing HIV Risk
Kisumu, Kenya

HIV self-testing can overcome barriers to HIV testing, but its potential as an HIV prevention strategy for women in sub-Saharan Africa has not been assessed. We examined whether sustained provision of self-tests to women promotes testing among sexual partners and reduces HIV incidence. We conducted a pair-matched cluster-randomised trial in 66 community clusters in Siaya County, Kenya. Clusters were communities with a high prevalence of transactional sex, including beach communities along Lake Victoria and inland communities with hotspots for transactional sex such as bars and hotels. We randomly assigned clusters to an intervention and comparison group. In intervention clusters, we provided participants with multiple self-tests at regular intervals and encouraged secondary distribution of self-tests to sexual partners. In comparison clusters, we provided participants referral cards for facility-based testing. The primary outcome of HIV incidence among all participants who contributed at least one HIV test was analysed using discrete-time mixed effects models. HIV incidence was not significantly different between the intervention and comparison groups. Social harms related to study participation occurred in three participants. Sustained provision of multiple self-tests to women at high risk of HIV infection in Kenya enabled secondary distribution of self-tests to sexual partners but did not affect HIV incidence.

This study is registered with ClinicalTrials.gov: NCT03135067.

Related Publications

• Trends in Transactional Sex Among Women at Risk for HIV in Rural Kenya During the First Year of the COVID-19 Pandemic
  JAMA Network Open (2022)
• The effect of providing women sustained access to HIV self-tests on male partner testing, couples testing, and HIV incidence in Kenya: a cluster-randomised trial
  The Lancet HIV (2021)
• ‘When I have these kits … I have confidence’ – HIV self-testing provides agency for women in their sexual decision-making
  Global Public Health (2021)
• Health and Economic Outcomes Associated With COVID-19 in Women at High Risk of HIV Infection in Rural Kenya
  JAMA Network Open (2021)

Keywords

HIV; HIV self-testing; female sex workers;partner testing; couples testing; transactional sex