Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study

• Published in: PloS one 2020-01, Vol.15 (1), p.e0227741-e0227741
• Main Authors: Okoboi, Stephen, Lazarus, Oucul, Castelnuovo, Barbara, Nanfuka, Mastula, Kambugu, Andrew, Mujugira, Andrew, King, Rachel
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS (Disease); Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Biology and Life Sciences; Counseling - methods; Counseling - organization & administration; Data collection; Discount coupons; Disease prevention; Gays & lesbians; Health sciences; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - blood; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV tests; Human immunodeficiency virus; Humans; Identification methods; Infections; Infectious diseases; Male; Mass Screening - instrumentation; Mass Screening - organization & administration; Mass Screening - standards; Medical diagnosis; Medical research; Medical tests; Medicine and Health Sciences; Mens health; Patient Participation - methods; Peer Group; Peers; People and Places; Pilot Projects; Program Evaluation; Public health; Public health movements; Reagent Kits, Diagnostic; Research and Analysis Methods; Self Care - instrumentation; Self Care - methods; Self testing; Self tests; Serologic Tests - instrumentation; Sex; Sexual and Gender Minorities; Sexually transmitted diseases; Standard of Care; STD; Surveys and Questionnaires; Uganda; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227741

One-in-three men who have sex with men (MSM) in Uganda have never tested for HIV. Peer-driven HIV testing strategies could increase testing coverage among non-testers. We evaluated the yield of peer distributed HIV self-test kits compared with standard-of-care testing approaches in identifying undiagnosed HIV infection. From June to August 2018, we conducted a pilot study of secondary distribution of HIV self-testing (HIVST) through MSM peer networks at The AIDS Support Organization (TASO) centres in Entebbe and Masaka. Peers were trained in HIVST use and basic HIV counselling. Each peer distributed 10 HIVST kits in one wave to MSM who had not tested in the previous six months. Participants who tested positive were linked by peers to HIV care. The primary outcome was the proportion of undiagnosed HIV infections. Data were analysed descriptively. A total of 297 participants were included in the analysis, of whom 150 received HIVST (intervention). The median age of HIVST recipients was 25 years (interquartile range [IQR], 22-28) compared to 28 years IQR (25-35) for 147 MSM tested using standard-of-care (SOC) strategies. One hundred forty-three MSM (95%) completed HIVST, of which 32% had never tested for HIV. A total of 12 participants were newly diagnosed with HIV infection: 8 in the peer HIVST group and 4 in the SOC group [5.6% vs 2.7%, respectively; P = 0.02]. All participants newly diagnosed with HIV infection received confirmatory HIV testing and were initiated on antiretroviral therapy. Peer distribution of HIVST through MSM networks is feasible and effective and could diagnose more new HIV infections than SOC approaches. Public health programs should consider scaling up peer-delivered HIVST for MSM.