Effect of peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social networks versus direct delivery.

Autor:	Shahmanesh M; Institute for Global Health, University College London, London, UK m.shahmanesh@ucl.ac.uk.; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., Mthiyane TN; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., Herbsst C; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., Neuman M; MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, London, UK., Adeagbo O; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., Mee P; London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, London, UK., Chimbindi N; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., Smit T; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., Okesola N; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., Harling G; Institute for Global Health, University College London, London, UK.; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa., McGrath N; Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa.; Faculty of medicine, University of Southampton, Southampton, Hampshire, UK., Sherr L; Institute for Global Health, University College London, London, UK., Seeley J; Department of Global Health &Development, London School of Hygiene and Tropical Medicine, London, UK., Subedar H; South African National Department of Health, Pretoria, South Africa., Johnson C; HIV, Hepatitis and STI Department, World Health Organisation, Geneva, Switzerland., Hatzold K; Population Services International, Washington, District of Columbia, USA., Terris-Prestholt F; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, London, UK., Cowan FM; Centre for Sexual Health HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK., Corbett EL; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.; TB-HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2021 Jul; Vol. 6 (Suppl 4).
DOI:	10.1136/bmjgh-2020-004574
Abstrakt:	Study Objective: We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators). Methods: We used restricted randomisation to allocate 24 peer navigator pairs (clusters) in KwaZulu-Natal 1:1:1: (1) standard of care ( SOC): peer navigators distributed clinic referrals, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) information to 18-30 year olds. (2) peer navigator direct distribution (PND): Peer navigators distributed HIVST packs (SOC plus two OraQuick HIVST kits) (3) incentivised peer networks (IPN): peer navigators recruited young community members (seeds) to distribute up to five HIVST packs to 18-30 year olds within their social networks. Seeds received 20 Rand (US$1.5) for each recipient who distributed further packs. The primary outcome was PrEP/ART linkage, defined as screening for PrEP/ART eligibility within 90 days of pack distribution per peer navigator month (pnm) of outreach, in women aged 18-24 (a priority for HIV prevention). Investigators and statisticians were blinded to allocation. Analysis was intention to treat. Total and unit costs were collected prospectively. Results: Between March and December 2019, 4163 packs (1098 SOC, 1480 PND, 1585 IPN) were distributed across 24 clusters. During 144 pnm, 272 18-30 year olds linked to PrEP/ART (1.9/pnm). Linkage rates for 18-24-year-old women were lower for IPN (n=26, 0.54/pnm) than PND (n=45, 0.80/pnm; SOC n=49, 0.85/pnm). Rate ratios were 0.68 (95% CI 0.28 to 1.66) for IPN versus PND, 0.64 (95% CI 0.26 to 1.62) for IPN versus SOC and 0.95 (95% CI 0.38 to 2.36) for PND versus SOC. In 18-30 year olds, PND had significantly more linkages than IPN (2.11 vs 0.88/pnm, RR 0.42, 95% CI 0.18 to 0.98). Cost per pack distributed was cheapest for IPN (US$36) c.f. SOC (US$64). Cost per person linked to PrEP/ART was cheaper in both peer navigator arms compared with IPN. Discussion: HIVST did not increase demand for PrEP/ART. Incentivised social network distribution reached large numbers with HIVST but resulted in fewer linkages compared with PrEP/ART promotion by peer navigators. Trial Registration Number: NCT03751826. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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