Following suggestions from prior studies that offering human immunodeficiency virus (HIV) self-testing (ST) kits may increase short-term HIV testing rates, researchers designed a randomized control trial to examine the impact of offering free oral HIVST to patients in Kenya. The report, published in Frontiers in Public Health, observed that providing HIVST kits through a clinic network had little effect on testing rates.

The study’s lead author, Elizabeth A. Kelvin, MD, PhD, theorized that clinic-based distribution of testing kits may be hindered by existing major barriers to testing, including “lack of time to go to a clinic, fear of knowing one’s status, and low risk perception.”

The study recruited a total of 305 truck drivers from two clinics in Kenya and offered them free oral HIVST kits. The intervention arm participants could receive HIVST kits from eight clinics. In the six-month follow-up, there was no increase in testing in the intervention arm, relative to the standard of care arm.

The most commonly reported reasons for not testing were lack of time (69.6%), low risk (27.2%), fear of knowing HIV status (20.8%), and that the patient had tested recently (8.0%). The null association was not modified by testing participants at baseline (P = 0.613), or when accounting for patients’ baseline risk behaviors, such as number of partners in past six months (P = 0.881), transactional sex in past 6 months (P = 0.599), or greater than half of the past 30 nights away from home for work (P = 0.304).

The study’s collaborators did observe that HIV testing preferences were aligned with standard of care guidelines for most participants, but patients in the intervention arm displayed a preference for oral swab HIVST after they had the opportunity to try it. The authors speculated that patients’ preferences could change with more knowledge of testing methods.

Despite the previous finding that patients offered HIVST were more likely to accept testing, the clinic-based distribution model may not be optimal for increasing long-term testing rates in this population.


Source: Frontiers in Public Health