Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
J Acquir Immune Defic Syndr. 2020 Jul 1;84(3):271-279. doi: 10.1097/QAI.0000000000002341.
In Uganda, HIV testing rates are approximately 90% among women in antenatal care, with male rates much lower. The World Health Organization has recommended HIV self-testing (HIVST), and one promising model is for women in antenatal care to deliver HIVST kits to their male partners. We investigated the impact of this model on male partner testing rates.
Three high-volume antenatal clinics in central Uganda.
We implemented a cluster-randomized controlled trial comparing standard of care to intervention, with the primary outcome of self-reported male partner HIV testing. Women and male partners were followed at 1 and 3 months. We used unadjusted analyses and log-linear models with an intent-to-treat approach accounting for clustering.
Study coordinators randomized 1514 women (777 intervention and 737 control). Baseline characteristics were balanced across arms with mean age (SD) of 25.2 (5.5) years and >44% with secondary education or higher. More male partners tested for HIV in intervention [576/746 (77.2%)] versus control [264/709 (37.2%)], P < 0.01. We identified 34 HIV-positive men in intervention versus 10 in control, with 6/26 (23%) and 4/6 (67%), respectively, reporting linking to care.
Our results demonstrate an enormous increase in self-reported partner HIV testing when HIVST is available at home. However, men testing positive through HIVST appeared less likely to link to care than men testing positive at a clinic. These results highlight the potential of HIVST in increasing HIV testing rates, while underscoring the importance of developing effective approaches to maximizing linkage to care among those testing positive through HIVST.
在乌干达，接受产前护理的女性中约有 90%接受了 HIV 检测，而男性的检测率则低得多。世界卫生组织（WHO）建议进行 HIV 自我检测（HIVST），其中一种有前途的模式是让接受产前护理的妇女将 HIVST 检测包交给其男性伴侣。我们调查了这种模式对男性伴侣检测率的影响。
乌干达中部的三个高容量产前诊所。
我们实施了一项集群随机对照试验，将标准护理与干预进行比较，主要结局是自我报告的男性伴侣 HIV 检测。对女性和男性伴侣在 1 个月和 3 个月时进行随访。我们使用未调整的分析和对数线性模型，采用意向治疗方法，考虑到聚类。
研究协调员对 1514 名女性（干预组 777 名，对照组 737 名）进行了随机分组。两组的基线特征均衡，平均年龄（SD）分别为 25.2（5.5）岁，超过 44%的人接受过中等或高等教育。干预组中有更多的男性伴侣接受了 HIV 检测[746/777（576）]，而对照组中只有 264/709（37.2%），P<0.01。在干预组中发现了 34 名 HIV 阳性男性，而在对照组中只有 10 名，分别有 6/26（23%）和 4/6（67%）报告已经联系上了医疗服务。
我们的研究结果表明，当家庭中提供 HIVST 时，自我报告的伴侣 HIV 检测率显著增加。然而，通过 HIVST 检测呈阳性的男性与在诊所检测呈阳性的男性相比，联系医疗服务的可能性较低。这些结果突出了 HIVST 在提高 HIV 检测率方面的潜力，同时强调了开发有效方法以最大限度地提高通过 HIVST 检测呈阳性者联系医疗服务的重要性。
