Partner self-testing could be a vital tool to increase uptake of HIV testing among men in sub-Saharan Africa
Near-universal uptake of HIV testing among men who were given self-tests by their partners in Kenya shows its feasibility as an intervention to reach hard-to-reach groups.
Providing pregnant and post-partum women with HIV self-testing kits for their partners gets more men testing for HIV than the more traditional method of inviting men to the clinic to test, according to new research conducted in Kenya and published in PLOS Medicine.
The study saw a self-testing rate of over 90% compared to just over 50% from the more traditional method.
Despite progress in recent years to increase access to HIV testing, men in sub-Saharan Africa are less likely to test for HIV than woman. Getting male partners of expectant mothers to test is vital to improve prevention of mother-to-child transmission (PMTCT) of HIV for a number of reasons – but it remains uncommon in many countries in the region.
Couples testing can result in safer sexual behaviours, higher uptake of HIV treatment for the HIV-positive partner, improved access to pre-exposure prophylaxis (PrEP) for the HIV-negative partner, and also increases uptake and adherence to PMTCT services.
In Kenya, four out of every ten new HIV infections occur within stable, heterosexual relationships. Also, a large majority of people in serodiscordant relationships – where one partner is HIV positive and the other is not – are unaware of their HIV status.
This means that promoting couples testing for HIV is a vital strategy adopted by many countries in the region. However, efforts to get men through the doors of traditional testing settings, such as clinics or hospitals, have had disappointing results. HIV self-testing could be a promising answer that addresses some of the barriers to men testing.
The World Health Organization (WHO) has recognised the importance of self-testing as an intervention. It recently (29 November) released guidelines to help countries implement self-testing policies with the aim of increasing HIV testing among hard to reach groups.
In this particular study, 600 antenatal and post-partum women in Kisumu, Kenya, were divided into two groups. Members of one group were given two HIV self-testing kits and encouraged to invite their male partners to test in the home, or to even test together. People in the other group were given a card inviting men to visit the clinic to test for HIV and were encouraged to give it to their partners – the norm across sub-Saharan Africa.
HIV testing rates were significantly higher in the self-testing group over the three-month period of the study – 90.8% of male partners tested in this group compared to 51.7% in the card distribution group.
The study was limited by self reporting of HIV testing, which is a common limitation of studies on HIV self-testing because of the nature of how self-testing takes place – in private. The study authors believe that reporting bias in this case was minimal, but note that in order to overcome this self-testing study limitation in the future, larger studies are needed that also look at linkages to HIV treatment care – an outcome which this study did not measure specifically.
Another limitation of the study was the high amount – roughly one-third – of women who declined to take part. This doesn't impact the study results, but does limit the potential impact of a generalised policy. Some of these women were simply not interested in the HIV status of their partner. Other women reported fear of intimate partner violence if they were to give their partners a self-test.
Intimate partner violence was a concern generally for the study, as 27% of women reported partner violence in the past 12 months. But the study showed that secondary distribution of HIV self-tests resulted in no reports of violence. This outcome echoes other studies among populations at a high risk of violence, such as sex workers, suggesting that intimate partner violence among women offering self-tests to male partners is rare.
The researchers remark that the study "provides key insights into a strategy – secondary distribution of self-tests to sexual partners – that may become common in many populations in SSA and elsewhere as HIV self-tests become more widely available whether formally endorsed or not."
While more research is needed into the feasibility of scaling-up access to HIV self-testing in certain settings, secondary distribution among key affected populations – not limited to heterosexual men in Africa – could be a vital tool for reaching at-risk groups with HIV testing and treatment services.