Journal Article

Community-led delivery of HIV self-testing to improve HIV testing, ART initiation and broader social outcomes in rural Malawi: study protocol for a cluster-randomised trial

Johnson, Cheryl C., Corbett, Elizabeth L., Kumwenda, Moses K., Fielding, Katherine, Nzawa, Rebecca, Nyirenda, Rose, Terris-Prestholt, Fern, Indravudh, Pitchaya P., Baggaley, Rachel C., Chilongosi, Richard, Desmond, Nicola, Hatzold, Karin

2019

Overview

Background Prevention of new HIV infections is a critical public health issue. The highest HIV testing gaps are in men, adolescents 15–19 years old, and adults 40 years and older. Community-based HIV testing services (HTS) can contribute to increased testing coverage and early HIV diagnosis, with HIV self-testing (HIVST) strategies showing promise. Community-based strategies, however, are resource intensive, costly and not widely implemented. A community-led approach to health interventions involves supporting communities to plan and implement solutions to improve their health. This trial aims to determine if community-led delivery of HIVST can improve HIV testing uptake, ART initiation, and broader social outcomes in rural Malawi. Methods The trial uses a parallel arm, cluster-randomised design with group village heads (GVH) and their defined catchment areas randomised (1:1) to community-led HIVST or continue with the standard of the care (SOC). As part of the intervention, informal community health cadres are supported to plan and implement a seven-day HIVST campaign linked to HIV treatment and prevention. Approximately 12 months after the initial campaign, intervention GVHs are randomised to lead a repeat HIVST campaign. The primary outcome includes the proportion of adolescents 15–19 years old who have tested for HIV in their lifetime. Secondary outcomes include recent testing in adults 40 years and older and men; ART initiation; knowledge of HIV prevention; and HIV testing stigma. Outcomes will be measured through cross-sectional surveys and clinic registers. Economic evaluation will determine the cost per person tested, cost per person diagnosed, and incremental cost effectiveness ratio. Discussion To the best of our knowledge, this is the first trial to assess the effectiveness of community-led HTS, which has only recently been enabled by the introduction of HIVST. Community-led delivery of HIVST is a promising new strategy for providing periodic HIV testing to support HIV prevention in rural communities. Further, introduction of HIVST through a community-led framework seems particularly apt, with control over healthcare concurrently devolved to individuals and communities. Trial registration Clinicaltrials.gov registry ( NCT03541382 ) registered 30 May 2018.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adolescents / Adult / Adults / AIDS treatment / Analysis / Anti-Retroviral Agents - therapeutic use / Antiretroviral drugs / Antiretroviral therapy / Care and treatment / Catchment areas / Clinical trials / Clusters / Community involvement / Community mobilisation / Community Networks / Community-led / Cost effectiveness / Cost-Benefit Analysis / Cross-Sectional Studies / Diagnosis / Disease prevention / Female / Health Promotion / HIV / HIV and co-infections / HIV carriers discrimination / HIV infections / HIV Infections - diagnosis / HIV Infections - drug therapy / HIV self-testing / HIV testing / HIV tests / Human immunodeficiency virus / Humans / Infection / Infectious Diseases / Internal Medicine / Malawi / Male / Mass Screening - economics / Mass Screening - methods / Medical Microbiology / Medical tests / Medicine / Medicine & Public Health / Parasitology / Public health / Randomization / Randomized Controlled Trials as Topic / Registries / Rural areas / Rural communities / Self testing / Self-rated health / Serologic Tests - economics / Serologic Tests - methods / Sexually transmitted disease prevention / Study Protocol / Tropical Medicine / Young Adult