Self-test kits and financial incentives can increase male HIV testing
Individual HIV tests, combined with financial incentives, increase the frequency of male visits to medical institutions for systematic diagnosis. Such a conclusion was reached by a group of British scientists on the basis of an analysis of the data of participants living in several regions of eastern and southern Africa. The results were published in PLoS Medicine.
According to experts, at present men, especially in low- and middle-income countries and high HIV burdens, do not receive a sufficient number of services for diagnosing the virus. Therefore, they remain a priority target group for HIV testing.
In some regions of Eastern and Southern Africa, only 52% of men living with HIV are aware of their status, and mortality from AIDS-related diseases in this group is 27% higher than that of women.
Individual HIV testing, when people self-diagnose (using a sample of saliva or blood) and interpret its results, is becoming more common, which means it helps to increase the coverage and frequency of testing among men who are at high risk of infection.
A group of scientists from the London School of Hygiene and Tropical Medicine, Warwick Medical School, Institute of Psychology, Health and Society of the University of Liverpool and other organizations conducted a study aimed at identifying interventions that could increase the level of testing for men and influence the subsequent decision on a systematic HIV diagnosis. To do this, experts suggested that pregnant women attending antenatal clinics should provide individual diagnostic kits for HIV testing.
As the authors point out, pregnant African women coming to the consultation have almost 100% diagnostic coverage. This, scientists considered, provides an ideal opportunity to engage their partners in testing.
Thus, in this adaptive study, the effect of self-testing on HIV was studied both separately and with the help of additional interventions, and the relationship with the diagnosis was evaluated in the group of partners of pregnant women attending a consultation (ISRCTN 18421340).
Over 2.3 thousand women from Malawi took part in the study, and they visited one of the three clinics for antenatal care in Blantyre between 2016 and 2017. Partners of all women participating in the work did not take ART and did not know about their HIV status.
Volunteers were randomly divided into several groups:
In the first, by means of a personalized invitation letter, a woman’s partner was invited to visit an HIV testing clinic and receive post-test services;
In the second, it was proposed to use 1 of 5 types of intervention:
- 2 HIV self-test kits were provided to women for her and her partner;
- 2 HIV self-test kits were provided to women for her and her partner, as well as a fixed financial incentive of $ 3;
- women were provided with 2 HIV self-test kits for her and her partner, as well as a fixed financial incentive of $ 10;
- women were given 2 HIV self-test kits for her and her partner and a 10% chance to receive $ 30 in the lottery; and
- 2 HIV self-test kits were provided to women for her and her partner and a reminder by phone for a partner.
The primary results were the proportion of male partners who were tested for HIV and for 28 days after giving birth, the women monitored their status and were regularly tested.
The results showed that HIV testing among men increased when pregnant women attending the clinic were given individual test kits.
Compared to the current standard of care, diagnostics involving male partners in the issuance of self-test kits increased from 17% to approximately 87% and 95%.
Subsequent visits to the clinic by men within 28 days after the birth of their partner was:
- 13.0% in the standard care group,
- 17.5% in the group with 2 sets for self-diagnosis,
- 40.9% in the group with 2 sets for self-diagnosis and $ 3,
- 51.7% in the group with 2 sets for self-diagnosis and $ 10,
- 18.6% in the group with 2 sets for self-diagnosis and a lottery and
- 22.3% in the group with 2 sets for self-diagnosis and reminder by phone.
After analyzing the results of the work, the authors of the study concluded that the chances of affecting men in terms of testing for HIV and systematically influencing it on a virus were significantly increased using conditionally fixed financial incentives and HIV self-test kits.