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

Human Immunodeficiency Virus Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03135067
• Other study ID #: 828100
• Secondary ID: R01MH111602
• Status: Completed
• Phase: N/A
• Start date: June 4, 2017
• Est. completion date: March 25, 2020

Study information

• Verified date: November 2022
• Source: University of Pennsylvania
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This cluster randomized trial will assess whether the provision of multiple oral-fluid based HIV self-test kits to HIV-negative women at high risk of acquiring HIV in western Kenya is an approach that promotes HIV testing among women's sexual partners, facilitates better sexual decision making, and reduces women's risk of acquiring HIV.

Description:

The study will recruit HIV-negative adult women who had two or more sexual partners within the past four weeks in the Nyanza region of Kenya. Beach communities and female sex worker hotspots will be randomized to an intervention group or a control group. In intervention clusters, participants will receive multiple oral fluid-based HIV test kits over a period of up to 24 months, training on how to use the tests, and encouragement to offer tests to current and potential sexual partners with whom sex without condoms is likely. In the comparison clusters, participants will be given referral vouchers for clinic-based HIV testing over a period of up to 24-months and encouraged to distribute these vouchers to sexual partners. Data will be collected from study participants at baseline on demographic and socio-economic characteristics, self-reported sexual behavior, HIV testing history, intimate partner violence history, and mental health outcomes. Follow-up data collection will occur every 6 months. Each month, participants will be sent an invitation to participate in short mobile phone based text message surveys. HIV testing of participants will occur at baseline and at 6 monthly intervals. Based on their reported use of the HIV self-tests, participants will be invited for qualitative interviews to learn more about their interactions with partners with regard to the distribution of self-tests and referral vouchers. Participants will also be given information to distribute to some of their male partners so that those partners can contact study staff to participate in qualitative interviews that will inquired about their perceptions of self-tests. The study has 3 specific aims. Aim 1 will determine the intervention's effect on uptake of HIV testing and identification of HIV infection among participants' sexual partners, self-reported sexual behavior of participants with partners whose HIV status was HIV-positive or not known, and HIV incidence among participants. Aim 2 will use a mixed methods approach to assessing safety and perceptions of the intervention by participants and their sexual partners. Aim 3 will assess the cost-effectiveness of the intervention and obtain information necessary to inform scale-up of the intervention in Kenya and other countries.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2102
• Est. completion date: March 25, 2020
• Est. primary completion date: March 25, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• At least 18 years old
• Currently resides in the study area
• Has resided in the study area for at least 6 months in the year prior to enrollment
• Intends to stay in the study area for at least 24 months
• Reports two or more sexual partners within the past 4 weeks at time of screening
• HIV negative
• Ownership or access to a mobile phone
• Willing and able to provide informed consent

Exclusion Criteria:

• Younger than 18 years old
• Does not currently live in the study area or has not for 6 of the last 12 months, or does not plan to for at least the next 24 months
• Fewer than two sexual partners in the last four weeks at time of screening
• HIV positive
• Has no access to a mobile phone
• Enrolled in another HIV prevention study
• Cannot or will not provide informed consent
• Males will self-select to participate by contacting the study staff using the information provided by willing index participants. There are no inclusion or exclusion criteria for the men who select to participate.

Related Conditions & MeSH terms

• Acquired Immunodeficiency Syndrome
• HIV Infections
• Human Immunodeficiency Virus

Intervention

Behavioral:
• Provision of multiple self-tests
Participants will be given multiple Oraquick Advance HIV-1/2 test kits for testing themselves more frequently and for offering to selected sexual partners. The self-test kits will be given to participants on a monthly basis as needed. The intervention is designed to facilitate partner and couples testing, with resulting reduction in risky sexual behavior and HIV incidence among participants.

Locations

Country	Name	City	State
Kenya	Impact Research and Development Organization	Kisumu

Sponsors (5)

Lead Sponsor	Collaborator
University of Pennsylvania	Impact Research & Development Organization, National Institute of Mental Health (NIMH), RTI International, University of North Carolina

Country where clinical trial is conducted

Kenya, 

References & Publications (46)

Alary M, Lowndes CM. The central role of clients of female sex workers in the dynamics of heterosexual HIV transmission in sub-Saharan Africa. AIDS. 2004 Apr 9;18(6):945-7. doi: 10.1097/00002030-200404090-00013. No abstract available. — View Citation

Balan IC, Carballo-Dieguez A, Frasca T, Dolezal C, Ibitoye M. The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men. AIDS Behav. 2014 Feb;18(2):254-62. doi: 10.1007/s10461-013-0497-x. — View Citation

Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, Sherman SG, Kerrigan D. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012 Jul;12(7):538-49. doi: 10.1016/S1473-3099(12)70066-X. Epub 2012 Mar 15. — View Citation

Bernard, H.R., Research Methods in Anthropology. 1995, Walnut Creek Altamira Press 535.

Beyrer C, Crago AL, Bekker LG, Butler J, Shannon K, Kerrigan D, Decker MR, Baral SD, Poteat T, Wirtz AL, Weir BW, Barre-Sinoussi F, Kazatchkine M, Sidibe M, Dehne KL, Boily MC, Strathdee SA. An action agenda for HIV and sex workers. Lancet. 2015 Jan 17;385(9964):287-301. doi: 10.1016/S0140-6736(14)60933-8. Epub 2014 Jul 22. — View Citation

Bwambale FM, Ssali SN, Byaruhanga S, Kalyango JN, Karamagi CA. Voluntary HIV counselling and testing among men in rural western Uganda: implications for HIV prevention. BMC Public Health. 2008 Jul 30;8:263. doi: 10.1186/1471-2458-8-263. — View Citation

Camlin CS, Kwena ZA, Dworkin SL. Jaboya vs. jakambi: Status, negotiation, and HIV risks among female migrants in the "sex for fish" economy in Nyanza Province, Kenya. AIDS Educ Prev. 2013 Jun;25(3):216-31. doi: 10.1521/aeap.2013.25.3.216. — View Citation

Carballo-Dieguez A, Frasca T, Balan I, Ibitoye M, Dolezal C. Use of a rapid HIV home test prevents HIV exposure in a high risk sample of men who have sex with men. AIDS Behav. 2012 Oct;16(7):1753-60. doi: 10.1007/s10461-012-0274-2. — View Citation

Carballo-Dieguez A, Frasca T, Dolezal C, Balan I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res. 2012;49(4):379-87. doi: 10.1080/00224499.2011.647117. Epub 2012 Jan 31. — View Citation

Chamie G, Clark TD, Kabami J, Kadede K, Ssemmondo E, Steinfeld R, Lavoy G, Kwarisiima D, Sang N, Jain V, Thirumurthy H, Liegler T, Balzer LB, Petersen ML, Cohen CR, Bukusi EA, Kamya MR, Havlir DV, Charlebois ED. A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study. Lancet HIV. 2016 Mar;3(3):e111-9. doi: 10.1016/S2352-3018(15)00251-9. Epub 2016 Jan 26. — View Citation

Choko AT, Desmond N, Webb EL, Chavula K, Napierala-Mavedzenge S, Gaydos CA, Makombe SD, Chunda T, Squire SB, French N, Mwapasa V, Corbett EL. The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi. PLoS Med. 2011 Oct;8(10):e1001102. doi: 10.1371/journal.pmed.1001102. Epub 2011 Oct 4. — View Citation

Choko AT, MacPherson P, Webb EL, Willey BA, Feasy H, Sambakunsi R, Mdolo A, Makombe SD, Desmond N, Hayes R, Maheswaran H, Corbett EL. Uptake, Accuracy, Safety, and Linkage into Care over Two Years of Promoting Annual Self-Testing for HIV in Blantyre, Malawi: A Community-Based Prospective Study. PLoS Med. 2015 Sep 8;12(9):e1001873. doi: 10.1371/journal.pmed.1001873. eCollection 2015 Sep. — View Citation

Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and Acceptability on HIV Self-testing Among Key Populations: A Literature Review. AIDS Behav. 2015 Nov;19(11):1949-65. doi: 10.1007/s10461-015-1097-8. — View Citation

Golden MR, Kerani RP, Stenger M, Hughes JP, Aubin M, Malinski C, Holmes KK. Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: the Washington State community-level randomized trial of EPT. PLoS Med. 2015 Jan 15;12(1):e1001777. doi: 10.1371/journal.pmed.1001777. eCollection 2015 Jan. — View Citation

Guidance on Couples HIV Testing and Counselling Including Antiretroviral Therapy for Treatment and Prevention in Serodiscordant Couples: Recommendations for a Public Health Approach. Geneva: World Health Organization; 2012 Apr. Available from http://www.ncbi.nlm.nih.gov/books/NBK138278/ — View Citation

Jakubowski A, Omanga E, Agot K, Thirumurthy H. Large Price Premiums for Unprotected Sex Among Female Sex Workers in Kenya: A Potential Challenge for Behavioral HIV Prevention Interventions. J Acquir Immune Defic Syndr. 2016 May 1;72(1):e20-2. doi: 10.1097/QAI.0000000000000929. No abstract available. — View Citation

Johnson C, Baggaley R, Forsythe S, van Rooyen H, Ford N, Napierala Mavedzenge S, Corbett E, Natarajan P, Taegtmeyer M. Realizing the potential for HIV self-testing. AIDS Behav. 2014 Jul;18 Suppl 4:S391-5. doi: 10.1007/s10461-014-0832-x. — View Citation

Kalibala S, Tun W, Cherutich P, Nganga A, Oweya E, Oluoch P. Factors associated with acceptability of HIV self-testing among health care workers in Kenya. AIDS Behav. 2014 Jul;18 Suppl 4(Suppl 4):S405-14. doi: 10.1007/s10461-014-0830-z. — View Citation

Kalibala, S., W. Tun, and W. Muraah, Feasibility and acceptability of HIV self testing among health care workers: results of a pilot programme in two hospitals in Kenya, in XVIII International AIDS Conference, Abstract WEPDC205, Editor. 2010: Vienna, Austria 18-23 July.

Kimbrough LW, Fisher HE, Jones KT, Johnson W, Thadiparthi S, Dooley S. Accessing social networks with high rates of undiagnosed HIV infection: The social networks demonstration project. Am J Public Health. 2009 Jun;99(6):1093-9. doi: 10.2105/AJPH.2008.139329. Epub 2009 Apr 16. — View Citation

Kiwanuka N, Ssetaala A, Nalutaaya A, Mpendo J, Wambuzi M, Nanvubya A, Sigirenda S, Kitandwe PK, Nielsen LE, Balyegisawa A, Kaleebu P, Nalusiba J, Sewankambo NK. High incidence of HIV-1 infection in a general population of fishing communities around Lake Victoria, Uganda. PLoS One. 2014 May 27;9(5):e94932. doi: 10.1371/journal.pone.0094932. eCollection 2014. — View Citation

Kumwenda M, Munthali A, Phiri M, Mwale D, Gutteberg T, MacPherson E, Theobald S, Corbett L, Desmond N. Factors shaping initial decision-making to self-test amongst cohabiting couples in urban Blantyre, Malawi. AIDS Behav. 2014 Jul;18 Suppl 4(Suppl 4):S396-404. doi: 10.1007/s10461-014-0817-9. — View Citation

Kwena Z, Mwanzo I, Shisanya C, Camlin C, Turan J, Achiro L, Bukusi E. Predictors of extra-marital partnerships among women married to fishermen along Lake Victoria in Kisumu County, Kenya. PLoS One. 2014 Apr 18;9(4):e95298. doi: 10.1371/journal.pone.0095298. eCollection 2014. — View Citation

Lee VJ, Tan SC, Earnest A, Seong PS, Tan HH, Leo YS. User acceptability and feasibility of self-testing with HIV rapid tests. J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):449-53. doi: 10.1097/QAI.0b013e318095a3f3. — View Citation

Masters SH, Agot K, Obonyo B, Napierala Mavedzenge S, Maman S, Thirumurthy H. Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial. PLoS Med. 2016 Nov 8;13(11):e1002166. doi: 10.1371/journal.pmed.1002166. eCollection 2016 Nov. — View Citation

Miles, M.H., A.H., Qualitative Data Analysis: An Expanded Sourcebook, 2nd Edition 1994, Thousand Oaks: Sage Publications

Napierala Mavedzenge S, Baggaley R, Corbett EL. A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention. Clin Infect Dis. 2013 Jul;57(1):126-38. doi: 10.1093/cid/cit156. Epub 2013 Mar 13. — View Citation

National AIDS and STD Control Programme, Guidelines for HIV Testing and Counselling in Kenya, Ministry of Public Health and Sanitation Kenya, Editor. 2008, Nairobi: NASCOP.

National AIDS and STI Control Programme (NASCOP), K., Kenya AIDS Indicator Survey 2012: Final Report. 2014, NASCOP: Nairobi.

National AIDS and STI Control Programme, Guidelines for HIV Testing Services in Kenya. 2015, Nairobi: National AIDS Control Programme.

National AIDS and STI Control Programme, Kenya AIDS Indicator Survey 2012: Nyanza Region Fact Sheet 2014, Nairobi, Kenya: NASCOP.

Ng'ang'a A, Waruiru W, Ngare C, Ssempijja V, Gachuki T, Njoroge I, Oluoch P, Kimanga DO, Maina WK, Mpazanje R, Kim AA; KAIS Study Group. The status of HIV testing and counseling in Kenya: results from a nationally representative population-based survey. J Acquir Immune Defic Syndr. 2014 May 1;66 Suppl 1(Suppl 1):S27-36. doi: 10.1097/QAI.0000000000000102. — View Citation

Odek WO, Githuka GN, Avery L, Njoroge PK, Kasonde L, Gorgens M, Kimani J, Gelmon L, Gakii G, Isac S, Faran E, Musyoki H, Maina W, Blanchard JF, Moses S. Estimating the size of the female sex worker population in Kenya to inform HIV prevention programming. PLoS One. 2014 Mar 3;9(3):e89180. doi: 10.1371/journal.pone.0089180. eCollection 2014. — View Citation

Orasure Techonologies, I., OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test Package Insert. Accessed 14 September 2011 http://www.orasure.com/products-infectious/products-infectious-oraquick.asp: Bethlehem, PA.

Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, Reza-Paul S, Lau J, Deering K, Pickles MR, Boily MC. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2015 Jan 3;385(9962):55-71. doi: 10.1016/S0140-6736(14)60931-4. Epub 2014 Jul 22. — View Citation

Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015 Dec 3;528(7580):S77-85. doi: 10.1038/nature16044. — View Citation

Skovdal M, Campbell C, Madanhire C, Mupambireyi Z, Nyamukapa C, Gregson S. Masculinity as a barrier to men's use of HIV services in Zimbabwe. Global Health. 2011 May 15;7:13. doi: 10.1186/1744-8603-7-13. — View Citation

Staveteig, S., et al., Demographic Patterns of HIV Testing Uptake in Sub-Saharan Africa. DHS Comparative Reports No. 30. Calverton, Maryland, USA: ICF International. 2013.

Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, Ajose O, Fakoya AO, Granich RM, Negussie EK, Baggaley RC. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med. 2013 Aug;10(8):e1001496. doi: 10.1371/journal.pmed.1001496. Epub 2013 Aug 13. — View Citation

Thirumurthy H, Masters SH, Mavedzenge SN, Maman S, Omanga E, Agot K. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV. 2016 Jun;3(6):e266-74. doi: 10.1016/S2352-3018(16)00041-2. Epub 2016 Apr 8. — View Citation

Thirumurthy, H., et al. Acceptability and feasibility of a novel approach to promote HIV testing in sexual and social networks using HIV self-tests. . in International AIDS Society (IAS) conference. 2015. Vancouver, Canada.

Unaids, THE GAP REPORT. 2014: Geneva, Switzerland.

Vandenhoudt HM, Langat L, Menten J, Odongo F, Oswago S, Luttah G, Zeh C, Crucitti T, Laserson K, Vulule J, Buve A. Prevalence of HIV and other sexually transmitted infections among female sex workers in Kisumu, Western Kenya, 1997 and 2008. PLoS One. 2013;8(1):e54953. doi: 10.1371/journal.pone.0054953. Epub 2013 Jan 23. — View Citation

Voeten HA, Egesah OB, Ondiege MY, Varkevisser CM, Habbema JD. Clients of female sex workers in Nyanza province, Kenya: a core group in STD/HIV transmission. Sex Transm Dis. 2002 Aug;29(8):444-52. doi: 10.1097/00007435-200208000-00003. — View Citation

WHO, Preventing HIV in Sex Work Settings in sub Saharan Africa. 2011, World Health Organization: Geneva.

World Health Organization, Consolidated Guidelines on HIV Testing Services. 2015, World Health Organization: Geneva, Switzerland.

* Note: There are 46 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Intimate Partner Violence (IPV)	Percentage of participants in each study group who experience IPV; Note that percentages are rounded to one decimal place.	Data was measured longitudinally up to 24 months for some subjects; all participants were measured through 18 months. Measures reported are from 18 month follow-up for behavior occurring in the past 6 months.
Primary	HIV Incidence Per 100 Person Years	HIV incidence over an average follow-up period of 18 months, and up to 24 months, per 100 person years	up to 24 months
Secondary	Identification of HIV-positive Male Partners	Average number of sexual partners per participant that the participant reported as HIV positive over the course of the study (Total reported positive sexual partners divided by number of participants who completed at least one 6-month follow-up survey); the intent of this measure is to see if participants given HIV self-tests are more likely to identify HIV positive sexual partners.	up to 24 months
Secondary	Used Condom With at Least One Partner After Partner Refused Self-test or HIV Testing Services Referral Card, or Tested HIV-positive	Percentage of participants who used a condom with at least one sexual partner after partner refused self-test or HIV testing services referral card, or tested HIV-positive; Note that percentages are rounded to one decimal place.	Data was measured longitudinally up to 24 months for some subjects; all participants were measured through 18 months. Measures reported are from 18 month follow-up for behavior occurring in the past 6 months.
Secondary	Couples Testing With Primary Partner	Percentage of participants who report testing together with their primary partner; Note that percentages are rounded to one decimal place.	Data was measured longitudinally up to 24 months for some subjects; all participants were measured through 18 months. Measures reported are from 18 month follow-up for behavior occurring in the past 6 months.
Secondary	Primary Partner Tested for HIV	Percentage of participants who report that their primary partner tested for HIV since enrollment; Note that percentages are rounded to one decimal place.	Data was measured longitudinally up to 24 months for some subjects; all participants were measured through 18 months. Measures reported are from 18 month follow-up for behavior occurring in the past 6 months.
Secondary	Declined Sex With at Least One Partner After Partner Refused Self-test or HIV Testing Services Referral Card, or Tested HIV-positive	Percentage of participants who declined sex with at least one partner after partner refused self-test or HIV testing services referral card, or tested HIV-positive; Note that percentages are rounded to one decimal place.	Data was measured longitudinally up to 24 months for some subjects; all participants were measured through 18 months. Measures reported are from 18 month follow-up for behavior occurring in the past 6 months.