Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial
Summary: Background: HIV self-testing increases testing uptake in sub-Saharan Africa but scale-up is challenging because of resource constraints. We evaluated an HIV self-testing intervention integrated into high-burden outpatient departments in Malawi. Methods: In this cluster-randomised trial, we...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-02-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X19305340 |
| _version_ | 1818292637816324096 |
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| author | Kathryn Dovel, PhD Frackson Shaba, MPH O Agatha Offorjebe, MD Kelvin Balakasi, BA Mike Nyirenda, MD Khumbo Phiri, MPH Sundeep K Gupta, MD Vincent Wong, MSc Chi-Hong Tseng, PhD Brooke E Nichols, PhD Refiloe Cele, MSc Eric Lungu, BA Tobias Masina, BA Thomas J Coates, ProfPhD Risa M Hoffman, MD |
| author_facet | Kathryn Dovel, PhD Frackson Shaba, MPH O Agatha Offorjebe, MD Kelvin Balakasi, BA Mike Nyirenda, MD Khumbo Phiri, MPH Sundeep K Gupta, MD Vincent Wong, MSc Chi-Hong Tseng, PhD Brooke E Nichols, PhD Refiloe Cele, MSc Eric Lungu, BA Tobias Masina, BA Thomas J Coates, ProfPhD Risa M Hoffman, MD |
| author_sort | Kathryn Dovel, PhD |
| collection | DOAJ |
| description | Summary: Background: HIV self-testing increases testing uptake in sub-Saharan Africa but scale-up is challenging because of resource constraints. We evaluated an HIV self-testing intervention integrated into high-burden outpatient departments in Malawi. Methods: In this cluster-randomised trial, we recruited participants aged 15 years or older from 15 outpatient departments at high-burden health facilities (including health centres, mission hospitals, and district hospitals) in central and southern Malawi. The trial was clustered at the health facility level. We used constrained randomisation to allocate each cluster (1:1:1) to one of the following groups: standard provider-initiated testing and counselling with no intervention (provider offered during consultations), optimised provider-initiated testing and counselling (with additional provider training and morning HIV testing), and facility-based HIV self-testing (Oraquick HIV self-test, group demonstration and distribution, and private spaces for interpretation and counselling). The primary outcome was the proportion of outpatients tested for HIV on the day of enrolment, measured through exit surveys with a sample of outpatients. Analyses were on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT03271307, and Pan African Clinical Trials, PACTR201711002697316. Findings: Between Sept 12, 2017, and Feb 23, 2018, 5885 outpatients completed an exit survey—2097 in the HIV self-testing group, 1951 in the standard provider-initiated testing and counselling group, and 1837 in the optimised provider-initiated testing and counselling group. 1063 (51%) of 2097 patients in the HIV self-testing group had HIV testing on the same day as enrolment, compared with 248 (13%) of 1951 in the standard provider-initiated testing and counselling group and 261 (14%) of 1837 in the optimised provider-initiated testing and counselling group. The odds of same-day HIV testing were significantly higher in the facility-based HIV self-testing group compared with either standard provider-initiated testing and counselling (adjusted odds ratio 8·52, 95% CI 3·98–18·24) or optimised provider-initiated testing and counselling (6·29, 2·96–13·38). Around 4% of those tested in the standard provider-initiated testing and counselling and optimised provider-initiated testing and counselling groups felt coerced to test, and around 1% felt coerced to share test results. No coercion was reported in the facility-based HIV self-testing group. Interpretation: Facility-based HIV self-testing increased HIV testing among outpatients in Malawi, with a minimal risk of adverse events. Facility-based HIV self-testing should be considered for scale-up in settings with a high unmet need for HIV testing. Funding: United States Agency for International Development. |
| first_indexed | 2024-12-13T03:03:08Z |
| format | Article |
| id | doaj.art-88b9a74cee6b4b1094ed476540865495 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-13T03:03:08Z |
| publishDate | 2020-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-88b9a74cee6b4b1094ed4765408654952022-12-22T00:01:47ZengElsevierThe Lancet Global Health2214-109X2020-02-0182e276e287Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trialKathryn Dovel, PhD0Frackson Shaba, MPH1O Agatha Offorjebe, MD2Kelvin Balakasi, BA3Mike Nyirenda, MD4Khumbo Phiri, MPH5Sundeep K Gupta, MD6Vincent Wong, MSc7Chi-Hong Tseng, PhD8Brooke E Nichols, PhD9Refiloe Cele, MSc10Eric Lungu, BA11Tobias Masina, BA12Thomas J Coates, ProfPhD13Risa M Hoffman, MD14Division of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USA; Partners in Hope, Lilongwe, Malawi; Correspondence to: Dr Kathryn Dovel, Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USAPartners in Hope, Lilongwe, MalawiDepartment of Medicine and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; School of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USAPartners in Hope, Lilongwe, MalawiPartners in Hope, Lilongwe, MalawiPartners in Hope, Lilongwe, MalawiDivision of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USAUSAID Global Health Bureau, Washington, DC, USADivision of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USAHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Global Health, School of Public Health, Boston University, Boston, MA, USAHealth Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaPartners in Hope, Lilongwe, MalawiMalawi Ministry of Health, HIV/AIDS Unit, Lilongwe, MalawiDivision of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USADivision of Infectious Diseases, University of California Los Angeles, Los Angeles, CA, USASummary: Background: HIV self-testing increases testing uptake in sub-Saharan Africa but scale-up is challenging because of resource constraints. We evaluated an HIV self-testing intervention integrated into high-burden outpatient departments in Malawi. Methods: In this cluster-randomised trial, we recruited participants aged 15 years or older from 15 outpatient departments at high-burden health facilities (including health centres, mission hospitals, and district hospitals) in central and southern Malawi. The trial was clustered at the health facility level. We used constrained randomisation to allocate each cluster (1:1:1) to one of the following groups: standard provider-initiated testing and counselling with no intervention (provider offered during consultations), optimised provider-initiated testing and counselling (with additional provider training and morning HIV testing), and facility-based HIV self-testing (Oraquick HIV self-test, group demonstration and distribution, and private spaces for interpretation and counselling). The primary outcome was the proportion of outpatients tested for HIV on the day of enrolment, measured through exit surveys with a sample of outpatients. Analyses were on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT03271307, and Pan African Clinical Trials, PACTR201711002697316. Findings: Between Sept 12, 2017, and Feb 23, 2018, 5885 outpatients completed an exit survey—2097 in the HIV self-testing group, 1951 in the standard provider-initiated testing and counselling group, and 1837 in the optimised provider-initiated testing and counselling group. 1063 (51%) of 2097 patients in the HIV self-testing group had HIV testing on the same day as enrolment, compared with 248 (13%) of 1951 in the standard provider-initiated testing and counselling group and 261 (14%) of 1837 in the optimised provider-initiated testing and counselling group. The odds of same-day HIV testing were significantly higher in the facility-based HIV self-testing group compared with either standard provider-initiated testing and counselling (adjusted odds ratio 8·52, 95% CI 3·98–18·24) or optimised provider-initiated testing and counselling (6·29, 2·96–13·38). Around 4% of those tested in the standard provider-initiated testing and counselling and optimised provider-initiated testing and counselling groups felt coerced to test, and around 1% felt coerced to share test results. No coercion was reported in the facility-based HIV self-testing group. Interpretation: Facility-based HIV self-testing increased HIV testing among outpatients in Malawi, with a minimal risk of adverse events. Facility-based HIV self-testing should be considered for scale-up in settings with a high unmet need for HIV testing. Funding: United States Agency for International Development.http://www.sciencedirect.com/science/article/pii/S2214109X19305340 |
| spellingShingle | Kathryn Dovel, PhD Frackson Shaba, MPH O Agatha Offorjebe, MD Kelvin Balakasi, BA Mike Nyirenda, MD Khumbo Phiri, MPH Sundeep K Gupta, MD Vincent Wong, MSc Chi-Hong Tseng, PhD Brooke E Nichols, PhD Refiloe Cele, MSc Eric Lungu, BA Tobias Masina, BA Thomas J Coates, ProfPhD Risa M Hoffman, MD Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial The Lancet Global Health |
| title | Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial |
| title_full | Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial |
| title_fullStr | Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial |
| title_full_unstemmed | Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial |
| title_short | Effect of facility-based HIV self-testing on uptake of testing among outpatients in Malawi: a cluster-randomised trial |
| title_sort | effect of facility based hiv self testing on uptake of testing among outpatients in malawi a cluster randomised trial |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X19305340 |
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