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Background: Too few men living with HIV are aware of their status, particularly in fishing communities around the great lakes of Africa. HIV self-testing (HIVST) addresses barriers preventing men from testing. But current approaches to distributing HIVST kits (e.g., through health facilities) only reach a subset of the men requiring HIV testing. We conducted a pilot trial of the distribution of HIVST kits through peer networks of fishermen.
Methods: We recruited seed participants among male patients of a TASO-supported facility. We introduced them to HIVST, and asked if they would distribute HIVST kits to peers who have not recently been tested for HIV. If so, we provided a package containing up to 5 HIVST kits (OraQuick), instructions and scripts addressing questions their peers may ask about HIVST. Recruited peers were referred to the study using a coupon with a unique number, and were asked to return the HIVST kit (used or unused). We conducted audio computer assisted self-interviews with seeds and recruits to measure a) the occurrence of adverse events (e.g., coercion) and b) the uptake of HIVST kits. The accuracy of HIVST was measured against a confirmatory HIV test conducted by a health worker.
Results: A total of 19 seeds offered an HIVST kit to 115 men, and 95 (82.6%) accepted the offer. Among those, 29 had never been tested (25.8%), and 42 (44.2%) had tested more than a year ago. According to confirmatory testing, HIV prevalence was 4.3% among recruits (4/94). Compared to this standard, the sensitivity of HIVST was 100%. Three men living with HIV learned of their infection through HIVST (yield = 1 new diagnosis per 6.3 seeds). The specificity of HIVST was 93.3% (88/94). The 6 false positives were due to a faint grey line appearing on the test location of the OraQuick kit. No recruit reported coercion, but one seed experienced hostility from family members of a recruit.
Conclusions: A novel network-based distribution model of HIVST had high uptake and yield among men in this pilot study. It could constitute a crucial tool in reaching the 90-90-90 targets in under-served fishing communities in Uganda and elsewhere.