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Background: There is a vital need to achieve higher uptake of HIV testing among men and couples in sub-Saharan Africa. Providing multiple HIV self-tests to individuals for distribution to their sexual partners, i.e. ''secondary distribution'', is a promising strategy with potential to increase awareness of HIV status. This strategy may be particularly useful for promoting male partner testing and couples testing in antenatal and postpartum settings.
Methods: We conducted a randomized trial at 3 clinics in Kisumu, Kenya (NCT02386215). Women seeking antenatal and postpartum care, aged 18-39 years, and reporting their primary partner was not known to be HIV-infected, were randomized to an HIV self-testing (HIVST) group or a comparison group. In the HIVST group, women were provided 2 OraQuick self-tests, a demonstration and instructions on how to use the self-tests, and encouragement to distribute a self-test to their partner. In the comparison group, women were provided invitation cards for their partner to seek counselor-administered HIV testing at the clinics. Follow-up interviews were conducted with women after they reported their partner had tested, and all women were interviewed at 3 months. The primary outcome was HIV testing by the male partner within 3 months and the secondary outcome was couples testing within 3 months. Chi-squared tests were used to compare outcomes in the intervention and comparison group.
Results: Between June 11, 2015 and October 16, 2015, 600 women were randomly assigned to the HIVST group (n=297) or the control group (n=303). Follow-up was completed for 570 (95.0%) women. Male partner testing uptake was 90.5% (257/284) in the HIVST group and 51.7% (148/286) in the comparison group (difference=38.7%, 95% CI 31.9%-45.5%, P < 0.001). Couples testing was also significantly higher in the HIVST group than the comparison group (75.0% vs. 33.2%, difference=41.7%, 95% CI 34.3%-49.2%, P < 0.001). One adverse event was reported in the HIVST group and none were reported in the comparison group.
Conclusions: Secondary distribution of HIV self-tests by pregnant and postpartum women was highly effective in promoting male partner and couples testing. As countries scale-up HIVST, further implementation of secondary distribution interventions can help increase HIV testing uptake among hard-to-reach populations.