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Effect of Peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social-networks versus direct delivery

Effect of Peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social-networks versus direct delivery
Effect of Peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social-networks versus direct delivery
Study objective We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators).

Methods We used restricted randomisation to allocate 24 peer navigator pairs (clusters) in KwaZulu-Natal 1:1:1: (1) standard of care (SOC): peer navigators distributed clinic referrals, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) information to 18–30 year olds. (2) peer navigator direct distribution (PND): Peer navigators distributed HIVST packs (SOC plus two OraQuick HIVST kits) (3) incentivised peer networks (IPN): peer navigators recruited young community members (seeds) to distribute up to five HIVST packs to 18–30 year olds within their social networks. Seeds received 20 Rand (US$1.5) for each recipient who distributed further packs. The primary outcome was PrEP/ART linkage, defined as screening for PrEP/ART eligibility within 90 days of pack distribution per peer navigator month (pnm) of outreach, in women aged 18–24 (a priority for HIV prevention). Investigators and statisticians were blinded to allocation. Analysis was intention to treat. Total and unit costs were collected prospectively.

Results Between March and December 2019, 4163 packs (1098 SOC, 1480 PND, 1585 IPN) were distributed across 24 clusters. During 144 pnm, 272 18–30 year olds linked to PrEP/ART (1.9/pnm). Linkage rates for 18–24-year-old women were lower for IPN (n=26, 0.54/pnm) than PND (n=45, 0.80/pnm; SOC n=49, 0.85/pnm). Rate ratios were 0.68 (95% CI 0.28 to 1.66) for IPN versus PND, 0.64 (95% CI 0.26 to 1.62) for IPN versus SOC and 0.95 (95% CI 0.38 to 2.36) for PND versus SOC. In 18–30 year olds, PND had significantly more linkages than IPN (2.11 vs 0.88/pnm, RR 0.42, 95% CI 0.18 to 0.98). Cost per pack distributed was cheapest for IPN (US$36) c.f. SOC (US$64). Cost per person linked to PrEP/ART was cheaper in both peer navigator arms compared with IPN.

Discussion HIVST did not increase demand for PrEP/ART. Incentivised social network distribution reached large numbers with HIVST but resulted in fewer linkages compared with PrEP/ART promotion by peer navigators.
HIV, cluster randomized trial, other diagnostic or tool, prevention strategies, public health
2059-7908
Shahmanesh, Maryam
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Mthiyane, Nondumiso
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Herbst, Carina
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Neuman, M
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Adeagbo, Oluwafemi
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Mee, P
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Dreyer, Jaco
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Chimbindi, Natsayi
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Smit, Theresa
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Okesola, Nonhlanhla
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Zuma, Thembelihle
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Harling, Guy
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Mcgrath, Nuala
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Sherr, Lorraine
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Seeley, Janet
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Subedar, H
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Johnson, C
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Hatzold, K
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Terris-Prestholt, Fern
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Cowan, Frances
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Corbett, Elizabeth L.
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Shahmanesh, Maryam
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Mthiyane, Nondumiso
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Herbst, Carina
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Neuman, M
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Adeagbo, Oluwafemi
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Mee, P
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Dreyer, Jaco
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Chimbindi, Natsayi
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Smit, Theresa
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Okesola, Nonhlanhla
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Harling, Guy
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Mcgrath, Nuala
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Sherr, Lorraine
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Seeley, Janet
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Subedar, H
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Johnson, C
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Hatzold, K
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Terris-Prestholt, Fern
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Cowan, Frances
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Corbett, Elizabeth L.
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Shahmanesh, Maryam, Mthiyane, Nondumiso, Herbst, Carina, Neuman, M, Adeagbo, Oluwafemi, Mee, P, Dreyer, Jaco, Chimbindi, Natsayi, Smit, Theresa, Okesola, Nonhlanhla, Zuma, Thembelihle, Harling, Guy, Mcgrath, Nuala, Sherr, Lorraine, Seeley, Janet, Subedar, H, Johnson, C, Hatzold, K, Terris-Prestholt, Fern, Cowan, Frances and Corbett, Elizabeth L. (2021) Effect of Peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social-networks versus direct delivery. BMJ Global Health, 6, [e004574]. (doi:10.1136/bmjgh-2020-004574).

Record type: Article

Abstract

Study objective We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators).

Methods We used restricted randomisation to allocate 24 peer navigator pairs (clusters) in KwaZulu-Natal 1:1:1: (1) standard of care (SOC): peer navigators distributed clinic referrals, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) information to 18–30 year olds. (2) peer navigator direct distribution (PND): Peer navigators distributed HIVST packs (SOC plus two OraQuick HIVST kits) (3) incentivised peer networks (IPN): peer navigators recruited young community members (seeds) to distribute up to five HIVST packs to 18–30 year olds within their social networks. Seeds received 20 Rand (US$1.5) for each recipient who distributed further packs. The primary outcome was PrEP/ART linkage, defined as screening for PrEP/ART eligibility within 90 days of pack distribution per peer navigator month (pnm) of outreach, in women aged 18–24 (a priority for HIV prevention). Investigators and statisticians were blinded to allocation. Analysis was intention to treat. Total and unit costs were collected prospectively.

Results Between March and December 2019, 4163 packs (1098 SOC, 1480 PND, 1585 IPN) were distributed across 24 clusters. During 144 pnm, 272 18–30 year olds linked to PrEP/ART (1.9/pnm). Linkage rates for 18–24-year-old women were lower for IPN (n=26, 0.54/pnm) than PND (n=45, 0.80/pnm; SOC n=49, 0.85/pnm). Rate ratios were 0.68 (95% CI 0.28 to 1.66) for IPN versus PND, 0.64 (95% CI 0.26 to 1.62) for IPN versus SOC and 0.95 (95% CI 0.38 to 2.36) for PND versus SOC. In 18–30 year olds, PND had significantly more linkages than IPN (2.11 vs 0.88/pnm, RR 0.42, 95% CI 0.18 to 0.98). Cost per pack distributed was cheapest for IPN (US$36) c.f. SOC (US$64). Cost per person linked to PrEP/ART was cheaper in both peer navigator arms compared with IPN.

Discussion HIVST did not increase demand for PrEP/ART. Incentivised social network distribution reached large numbers with HIVST but resulted in fewer linkages compared with PrEP/ART promotion by peer navigators.

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STAR RCT resubmitted_tracked_April2021_forPURE - Accepted Manuscript
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More information

Accepted/In Press date: 14 July 2021
e-pub ahead of print date: 26 July 2021
Additional Information: Funding This study is part of the Self-Testing Africa (STAR) initiative funded by the Unitaid (grant number: PO#10140-0-600). The US National Institute of Health (NIH) R01 (award number: 5R01MH114560-03) supports the peer navigator intervention to support uptake and retention of adolescents and young adults in existing HIV prevention. Africa Health Research Institute is supported by core funding from the Wellcome Trust (Core grant number (082384/Z/07/Z). N. McGrath is a recipient of an NIHR Research Professorship award (Ref: RP-2017–08-ST2-008).
Keywords: HIV, cluster randomized trial, other diagnostic or tool, prevention strategies, public health

Identifiers

Local EPrints ID: 450467
URI: http://eprints.soton.ac.uk/id/eprint/450467
ISSN: 2059-7908
PURE UUID: f7353db8-db07-484f-bddf-1d034397c891
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

Catalogue record

Date deposited: 28 Jul 2021 16:32
Last modified: 26 Nov 2021 06:36

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Contributors

Author: Maryam Shahmanesh
Author: Nondumiso Mthiyane
Author: Carina Herbst
Author: M Neuman
Author: Oluwafemi Adeagbo
Author: P Mee
Author: Jaco Dreyer
Author: Natsayi Chimbindi
Author: Theresa Smit
Author: Nonhlanhla Okesola
Author: Thembelihle Zuma
Author: Guy Harling
Author: Nuala Mcgrath ORCID iD
Author: Lorraine Sherr
Author: Janet Seeley
Author: H Subedar
Author: C Johnson
Author: K Hatzold
Author: Fern Terris-Prestholt
Author: Frances Cowan
Author: Elizabeth L. Corbett

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