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Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment

Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment
Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment
Background
To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - micro-incentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women.

Methods/design
This is a cluster randomized trial of 45 communities (clusters) in a rural area in the uMkhanyakude district of KwaZulu Natal, South Africa (2018–2021). The study is built upon the Africa Health Research Institute (AHRI)‘s HIV testing platform, which offers annual home-based rapid HIV testing to individuals aged 15 years and above. In a 2 × 2 factorial design, individuals aged ≥15 years living in the 45 clusters are randomly assigned to one of four arms: i) a financial micro-incentive (food voucher) (n = 8); ii) male-targeted HIV specific decision support (EPIC-HIV) (n = 8); iii) both the micro incentives and male-targeted decision support (n = 8); and iv) standard of care (n = 21). The EPIC-HIV application is developed and delivered via a tablet to encourage HIV testing and linkage to care among men. A mixed method approach is adopted to supplement the randomized control trial and meet the study aims.

Discussion
The findings of this trial will provide evidence on the feasibility and causal impact of two interventions - micro-incentives and a male-targeted HIV specific decision support - on uptake of home-based HIV testing, linkage to care, as well as population health outcomes including population viral load, HIV related mortality in men, and HIV incidence in young women (15-30 years of age).
1471-2458
1-10
Mathenjwa, Thulile
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Kim, Haeyoung
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Zuma, Thembelihle
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Shahmanesh, Maryam
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Seeley, Janet
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Matthews, Philippa
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Wyke, Sally
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Mcgrath, Nuala
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Sartorius, Ben
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Yapa, H.M.
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Adeagbo, Oluwafemi
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Blandford, Ann
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Dobra, Adrian
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Bäernighausen, Till
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Tanser, Frank
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Mathenjwa, Thulile
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Kim, Haeyoung
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Zuma, Thembelihle
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Shahmanesh, Maryam
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Seeley, Janet
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Matthews, Philippa
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Wyke, Sally
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Mcgrath, Nuala
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Sartorius, Ben
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Yapa, H.M.
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Adeagbo, Oluwafemi
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Blandford, Ann
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Dobra, Adrian
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Bäernighausen, Till
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Tanser, Frank
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Mathenjwa, Thulile, Kim, Haeyoung, Zuma, Thembelihle, Shahmanesh, Maryam, Seeley, Janet, Matthews, Philippa, Wyke, Sally, Mcgrath, Nuala, Sartorius, Ben, Yapa, H.M., Adeagbo, Oluwafemi, Blandford, Ann, Dobra, Adrian, Bäernighausen, Till and Tanser, Frank (2019) Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment. BMC Public Health, 19 (1), 1-10, [969]. (doi:10.1186/s12889-019-7277-0).

Record type: Article

Abstract

Background
To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - micro-incentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women.

Methods/design
This is a cluster randomized trial of 45 communities (clusters) in a rural area in the uMkhanyakude district of KwaZulu Natal, South Africa (2018–2021). The study is built upon the Africa Health Research Institute (AHRI)‘s HIV testing platform, which offers annual home-based rapid HIV testing to individuals aged 15 years and above. In a 2 × 2 factorial design, individuals aged ≥15 years living in the 45 clusters are randomly assigned to one of four arms: i) a financial micro-incentive (food voucher) (n = 8); ii) male-targeted HIV specific decision support (EPIC-HIV) (n = 8); iii) both the micro incentives and male-targeted decision support (n = 8); and iv) standard of care (n = 21). The EPIC-HIV application is developed and delivered via a tablet to encourage HIV testing and linkage to care among men. A mixed method approach is adopted to supplement the randomized control trial and meet the study aims.

Discussion
The findings of this trial will provide evidence on the feasibility and causal impact of two interventions - micro-incentives and a male-targeted HIV specific decision support - on uptake of home-based HIV testing, linkage to care, as well as population health outcomes including population viral load, HIV related mortality in men, and HIV incidence in young women (15-30 years of age).

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More information

Accepted/In Press date: 11 July 2019
e-pub ahead of print date: 19 July 2019

Identifiers

Local EPrints ID: 432500
URI: http://eprints.soton.ac.uk/id/eprint/432500
ISSN: 1471-2458
PURE UUID: 94075ff5-104a-48ff-babe-1930927addda
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

Catalogue record

Date deposited: 17 Jul 2019 16:30
Last modified: 26 Nov 2021 03:00

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Contributors

Author: Thulile Mathenjwa
Author: Haeyoung Kim
Author: Thembelihle Zuma
Author: Maryam Shahmanesh
Author: Janet Seeley
Author: Philippa Matthews
Author: Sally Wyke
Author: Nuala Mcgrath ORCID iD
Author: Ben Sartorius
Author: H.M. Yapa
Author: Oluwafemi Adeagbo
Author: Ann Blandford
Author: Adrian Dobra
Author: Till Bäernighausen
Author: Frank Tanser

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