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Harsha Thirumurthy - One of the best experts on this subject based on the ideXlab platform.
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factors associated with us public motivation to use and distribute covid 19 Self Tests
JAMA Network Open, 2021Co-Authors: Cedric H Biengund, Harsha Thirumurthy, Karen Dugosh, Trisha Acri, Kathleen A Brady, Jessica Fishman, Robert E GrossAbstract:This survey study examines factors associated with motivation to use and distribute Self-Tests for COVID-19 infection among US adults.
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male partner testing and sexual behaviour following provision of multiple hiv Self Tests to kenyan women at higher risk of hiv infection in a cluster randomized trial
Journal of the International AIDS Society, 2020Co-Authors: Sue Napierala, Elizabeth F Bair, Noora Marcus, Perez Ochwal, Suzanne Maman, Kawango Agot, Harsha ThirumurthyAbstract:INTRODUCTION Without significant increases in uptake of HIV testing among men, it will be difficult to reduce HIV incidence to disease elimination levels. Secondary distribution of HIV Self-Tests by women to their male partners is a promising approach for increasing male testing that is being implemented in several countries. Here, we examine male partner and couples testing outcomes and sexual decision making associated with this approach in a cluster randomized trial. METHODS We examined data from women at higher risk of HIV participating in the intervention arm of an ongoing pair-matched cluster randomized trial in Kenya. HIV-negative women ≥18 years who Self-reported ≥2 partners in the past month were eligible. Participants received Self-Tests at enrolment and three-monthly intervals. They were encouraged to offer Tests to sexual partners with whom they anticipated condomless sex. At six months, we collected data on Self-test distribution, male partner and couples testing, and testing and sexual behaviour in the three most recent transactional sex encounters. We used descriptive analyses and generalized estimating equation models to understand how sexual behaviour was influenced by Self-test distribution. RESULTS From January 2018 to April 2019, 921/1057 (87%) participants completed six-month follow-up. Average age was 28 years, 65% were married, and 72% reported income through sex work. Participants received 7283 Self-Tests over six months, a median of eight per participant. Participants offered a median three Self-Tests to sexual partners. Of participants with a primary partner, 94% offered them a Self-test. Of these, 97% accepted the test. When accepted, couples testing was reported among 91% of participants. Among 1954 transactional sex encounters, 64% included an offer to Self-test. When offered Self-Tests were accepted by 93% of partners, and 84% who accepted conducted couples testing. Compared to partners with an HIV-negative result, condom use was higher when men had a reactive result (56.3% vs. 89.7%, p < 0.01), were not offered a Self-test (56.3% vs. 62.0%, p = 0.02), or refused to Self-test (56.3% vs. 78.3, p < 0.01). CONCLUSIONS Providing women with multiple Self-Tests facilitated male partner and couples testing, and led to safer sexual behaviour. These findings suggest secondary distribution is a promising approach for reaching men and has HIV prevention potential. Clinical Trial Number: NCT03135067.
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Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe: A Randomized Clinical Trial
JAMA network open, 2019Co-Authors: Wei Chang, Karin Hatzold, Primrose Matambanadzo, Albert Takaruza, Euphemia L Sibanda, Frances M. Cowan, Harsha ThirumurthyAbstract:Importance HIV Self-testing is a promising approach for increasing awareness of HIV status in sub-Saharan Africa, particularly in Zimbabwe, where HIV prevalence is 13%. Evidence is lacking, however, on the optimal pricing policies and delivery strategies for maximizing the effect of HIV Self-testing. Objective To assess demand for HIV Self-testing among adults and priority-population subgroups under alternative pricing and distribution strategies. Design, Setting, and Participants This randomized clinical trial recruited study participants between February 15, 2018, and April 25, 2018, in urban and rural communities in Zimbabwe. A factorial design was used to randomize participants to a combination of Self-test price, distribution site, and promotional message. Individuals and their household members had to be at least 16 years old to be eligible for participation. This intention-to-treat population comprised 3996 participants. Interventions Participants were given a voucher that could be redeemed for an HIV Self-test within 1 month at varying prices (US $0-$3) and distribution sites (clinics or pharmacies in urban areas, and retail stores or community health workers in rural areas). Vouchers included randomly assigned promotional messages that emphasized the benefits of HIV testing. Main Outcomes and Measures Proportion of participants who obtained Self-Tests in each trial arm, measured by distributor records. Results Among the 4000 individuals enrolled, 3996 participants were included. In total, the mean (SD) age was 35 (14.7) years, and most participants (2841 [71.1%]) were female. Self-testing demand was highly price sensitive; 260 participants (32.5%) who were offered free Self-Tests redeemed their vouchers, compared with 55 participants (6.9%) who were offered Self-Tests for US $0.50 (odds ratio [OR], 0.14; 95% CI, 0.10-0.19), a reduction in demand of more than 25 percentage points. Demand was below 3% in the $1, $2, and $3 groups, which was statistically significantly lower than the demand in the free distribution group: in pooled analyses, demand was considerably lower among participants in higher-than-$0 price groups compared with the free distribution group (2.8% vs 32.5%; OR, 0.05; 95% CI, 0.04-0.07). In urban areas, demand was statistically significantly higher with pharmacy-based distribution compared with clinic-based distribution (6.8% vs 2.9%; adjusted OR, 2.78; 95% CI, 1.74-4.45). Price sensitivity was statistically significantly higher among rural residents, men, and those who had never received testing before. Promotional messages did not influence demand. Conclusions and Relevance This study found that demand for HIV Self-testing in Zimbabwe was highly price sensitive, suggesting that free distribution may be essential for promoting testing among high-priority population groups; additionally, pharmacy-based distribution was preferable to clinic-based distribution in urban areas. Trial Registration ClinicalTrials.gov identifier:NCT03559959
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acceptability and outcomes of distributing hiv Self Tests for male partner testing in kenyan maternal and child health and family planning clinics
AIDS, 2019Co-Authors: Jillian Pintye, Alison L Drake, Emily R Begnel, John Kinuthia, Felix Abuna, Harison Lagat, Julia C Dettinger, Anjuli D Wagner, Harsha ThirumurthyAbstract:Background Providing HIV Self-Tests to women for distribution to male partners may provide a unique opportunity to increase male partner and couples testing among women in HIV high-burden settings. Methods Between November 2017 and June 2018, we offered Self-Tests for at-home couples or partner HIV testing to HIV-uninfected women seeking routine maternal and child health and family planning services at eight facilities in Kisumu, Kenya. Women accepting Self-Tests were offered at least two Self-Tests (OraQuick) to take to their partner(s) with instructions on use. HIV Self-testing (HIVST) outcomes were evaluated using available programmatic data. Results Overall, 3620 women were offered Self-Tests for at-home male partner HIV testing. The median age was 24 years (interquartile range 21-28) and 81% were in monogamous marriages. Overall, 1422 (39%) women reported having a partner of unknown HIV status, of whom 755 (53%) accepted Self-Tests. Among women with partners of unknown HIV status who declined Self-Tests (n = 667), 49% reported needing to consult their partner. Pregnant women were more likely to accept HIVST than nonpregnant women (prevalence ratio = 1.2, 95% confidence interval 1.0-1.4, P = 0.013). Self-testing outcomes were ascertained for 389 (44%) women who accepted Self-Tests. Among these women, 93% offered HIVSTs to their male partner; of these, 95% reported their male partners used the Self-test and 99% used a Self-test with their partner. Conclusion Among women attending routine maternal and child health and family planning services who had male partners of unknown HIV status, over half accepted Self-Tests for partner testing. Most women with outcomes ascertained reported that male partners accepted and used Self-Tests and that couples testing occurred.
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a qualitative study of secondary distribution of hiv Self test kits by female sex workers in kenya
PLOS ONE, 2017Co-Authors: Suzanne Maman, Kawango Agot, Katherine R Murray, Sue Napierala Mavedzenge, Lennah Oluoch, Florence Sijenje, Harsha ThirumurthyAbstract:Promoting awareness of serostatus and frequent HIV testing is especially important among high risk populations such as female sex workers (FSW) and their sexual partners. HIV Self-testing is an approach that is gaining ground in sub-Saharan Africa as a strategy to increase knowledge of HIV status and promote safer sexual decisions. However, little is known about Self-test distribution strategies that are optimal for increasing testing access among hard-to-reach and high risk individuals. We conducted a qualitative study with 18 FSW who participated in a larger study that provided them with five oral fluid-based Self-Tests, training on how to use the Tests, and encouragement to offer the Self-Tests to their sexual partners using their discretion. Women demonstrated agency in the strategies they used to introduce Self-Tests to their partners and to avoid conflict with partners. They carefully considered with whom to share Self-Tests, often assessing the possibility for negative reactions from partners as part of their decision making process. When women faced negative reactions from partners, they drew on strategies they had used before to avoid conflict and physical harm from partners, such as not responding to angry partners and forgoing payment to leave angry partners quickly. Some women also used Self-Tests to make more informed sexual decisions with their partners.
Kawango Agot - One of the best experts on this subject based on the ideXlab platform.
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male partner testing and sexual behaviour following provision of multiple hiv Self Tests to kenyan women at higher risk of hiv infection in a cluster randomized trial
Journal of the International AIDS Society, 2020Co-Authors: Sue Napierala, Elizabeth F Bair, Noora Marcus, Perez Ochwal, Suzanne Maman, Kawango Agot, Harsha ThirumurthyAbstract:INTRODUCTION Without significant increases in uptake of HIV testing among men, it will be difficult to reduce HIV incidence to disease elimination levels. Secondary distribution of HIV Self-Tests by women to their male partners is a promising approach for increasing male testing that is being implemented in several countries. Here, we examine male partner and couples testing outcomes and sexual decision making associated with this approach in a cluster randomized trial. METHODS We examined data from women at higher risk of HIV participating in the intervention arm of an ongoing pair-matched cluster randomized trial in Kenya. HIV-negative women ≥18 years who Self-reported ≥2 partners in the past month were eligible. Participants received Self-Tests at enrolment and three-monthly intervals. They were encouraged to offer Tests to sexual partners with whom they anticipated condomless sex. At six months, we collected data on Self-test distribution, male partner and couples testing, and testing and sexual behaviour in the three most recent transactional sex encounters. We used descriptive analyses and generalized estimating equation models to understand how sexual behaviour was influenced by Self-test distribution. RESULTS From January 2018 to April 2019, 921/1057 (87%) participants completed six-month follow-up. Average age was 28 years, 65% were married, and 72% reported income through sex work. Participants received 7283 Self-Tests over six months, a median of eight per participant. Participants offered a median three Self-Tests to sexual partners. Of participants with a primary partner, 94% offered them a Self-test. Of these, 97% accepted the test. When accepted, couples testing was reported among 91% of participants. Among 1954 transactional sex encounters, 64% included an offer to Self-test. When offered Self-Tests were accepted by 93% of partners, and 84% who accepted conducted couples testing. Compared to partners with an HIV-negative result, condom use was higher when men had a reactive result (56.3% vs. 89.7%, p < 0.01), were not offered a Self-test (56.3% vs. 62.0%, p = 0.02), or refused to Self-test (56.3% vs. 78.3, p < 0.01). CONCLUSIONS Providing women with multiple Self-Tests facilitated male partner and couples testing, and led to safer sexual behaviour. These findings suggest secondary distribution is a promising approach for reaching men and has HIV prevention potential. Clinical Trial Number: NCT03135067.
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a qualitative study of secondary distribution of hiv Self test kits by female sex workers in kenya
PLOS ONE, 2017Co-Authors: Suzanne Maman, Kawango Agot, Katherine R Murray, Sue Napierala Mavedzenge, Lennah Oluoch, Florence Sijenje, Harsha ThirumurthyAbstract:Promoting awareness of serostatus and frequent HIV testing is especially important among high risk populations such as female sex workers (FSW) and their sexual partners. HIV Self-testing is an approach that is gaining ground in sub-Saharan Africa as a strategy to increase knowledge of HIV status and promote safer sexual decisions. However, little is known about Self-test distribution strategies that are optimal for increasing testing access among hard-to-reach and high risk individuals. We conducted a qualitative study with 18 FSW who participated in a larger study that provided them with five oral fluid-based Self-Tests, training on how to use the Tests, and encouragement to offer the Self-Tests to their sexual partners using their discretion. Women demonstrated agency in the strategies they used to introduce Self-Tests to their partners and to avoid conflict with partners. They carefully considered with whom to share Self-Tests, often assessing the possibility for negative reactions from partners as part of their decision making process. When women faced negative reactions from partners, they drew on strategies they had used before to avoid conflict and physical harm from partners, such as not responding to angry partners and forgoing payment to leave angry partners quickly. Some women also used Self-Tests to make more informed sexual decisions with their partners.
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promoting partner testing and couples testing through secondary distribution of hiv Self Tests a randomized clinical trial
PLOS Medicine, 2016Co-Authors: Samuel H Masters, Suzanne Maman, Kawango Agot, Sue Napierala Mavedzenge, Beatrice Obonyo, Harsha ThirumurthyAbstract:Background Achieving higher rates of partner HIV testing and couples testing among pregnant and postpartum women in sub-Saharan Africa is essential for the success of combination HIV prevention, including the prevention of mother-to-child transmission. We aimed to determine whether providing multiple HIV Self-Tests to pregnant and postpartum women for secondary distribution is more effective at promoting partner testing and couples testing than conventional strategies based on invitations to clinic-based testing. Methods and Findings We conducted a randomized trial in Kisumu, Kenya, between June 11, 2015, and January 15, 2016. Six hundred antenatal and postpartum women aged 18–39 y were randomized to an HIV Self-testing (HIVST) group or a comparison group. Participants in the HIVST group were given two oral-fluid-based HIV test kits, instructed on how to use them, and encouraged to distribute a test kit to their male partner or use both kits for testing as a couple. Participants in the comparison group were given an invitation card for clinic-based HIV testing and encouraged to distribute the card to their male partner, a routine practice in many health clinics. The primary outcome was partner testing within 3 mo of enrollment. Among 570 participants analyzed, partner HIV testing was more likely in the HIVST group (90.8%, 258/284) than the comparison group (51.7%, 148/286; difference = 39.1%, 95% CI 32.4% to 45.8%, p < 0.001). Couples testing was also more likely in the HIVST group than the comparison group (75.4% versus 33.2%, difference = 42.1%, 95% CI 34.7% to 49.6%, p < 0.001). No participants reported intimate partner violence due to HIV testing. This study was limited by Self-reported outcomes, a common limitation in many studies involving HIVST due to the private manner in which Self-Tests are meant to be used. Conclusions Provision of multiple HIV Self-Tests to women seeking antenatal and postpartum care was successful in promoting partner testing and couples testing. This approach warrants further consideration as countries develop HIVST policies and seek new ways to increase awareness of HIV status among men and promote couples testing. Trial Registration ClinicalTrials.gov NCT02386215.
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promoting male partner hiv testing and safer sexual decision making through secondary distribution of Self Tests by hiv negative female sex workers and women receiving antenatal and post partum care in kenya a cohort study
The Lancet HIV, 2016Co-Authors: Harsha Thirumurthy, Suzanne Maman, Sue Napierala Mavedzenge, Samuel H Masters, Eunice Omanga, Kawango AgotAbstract:Summary Background Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple Self-Tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making. Methods In this cohort study, HIV-negative women aged 18–39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV Tests. Participants enrolled at the health facility received three Self-Tests and those at the drop-in centre received five Self-Tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how Self-Tests were used. Outcomes included the number of Self-Tests distributed by participants, the proportion of participants whose sexual partners used a Self-test, couples testing, and sexual behaviour after Self-testing. Findings Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed Self-Tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one Self-test to commercial sex clients. Among Self-Tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among Tests received by primary and non-primary sexual partners, two (4%) of 53 Tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p Interpretation Provision of multiple HIV Self-Tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop Self-testing policies and programmes. Funding Bill & Melinda Gates Foundation.
Suzanne Maman - One of the best experts on this subject based on the ideXlab platform.
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male partner testing and sexual behaviour following provision of multiple hiv Self Tests to kenyan women at higher risk of hiv infection in a cluster randomized trial
Journal of the International AIDS Society, 2020Co-Authors: Sue Napierala, Elizabeth F Bair, Noora Marcus, Perez Ochwal, Suzanne Maman, Kawango Agot, Harsha ThirumurthyAbstract:INTRODUCTION Without significant increases in uptake of HIV testing among men, it will be difficult to reduce HIV incidence to disease elimination levels. Secondary distribution of HIV Self-Tests by women to their male partners is a promising approach for increasing male testing that is being implemented in several countries. Here, we examine male partner and couples testing outcomes and sexual decision making associated with this approach in a cluster randomized trial. METHODS We examined data from women at higher risk of HIV participating in the intervention arm of an ongoing pair-matched cluster randomized trial in Kenya. HIV-negative women ≥18 years who Self-reported ≥2 partners in the past month were eligible. Participants received Self-Tests at enrolment and three-monthly intervals. They were encouraged to offer Tests to sexual partners with whom they anticipated condomless sex. At six months, we collected data on Self-test distribution, male partner and couples testing, and testing and sexual behaviour in the three most recent transactional sex encounters. We used descriptive analyses and generalized estimating equation models to understand how sexual behaviour was influenced by Self-test distribution. RESULTS From January 2018 to April 2019, 921/1057 (87%) participants completed six-month follow-up. Average age was 28 years, 65% were married, and 72% reported income through sex work. Participants received 7283 Self-Tests over six months, a median of eight per participant. Participants offered a median three Self-Tests to sexual partners. Of participants with a primary partner, 94% offered them a Self-test. Of these, 97% accepted the test. When accepted, couples testing was reported among 91% of participants. Among 1954 transactional sex encounters, 64% included an offer to Self-test. When offered Self-Tests were accepted by 93% of partners, and 84% who accepted conducted couples testing. Compared to partners with an HIV-negative result, condom use was higher when men had a reactive result (56.3% vs. 89.7%, p < 0.01), were not offered a Self-test (56.3% vs. 62.0%, p = 0.02), or refused to Self-test (56.3% vs. 78.3, p < 0.01). CONCLUSIONS Providing women with multiple Self-Tests facilitated male partner and couples testing, and led to safer sexual behaviour. These findings suggest secondary distribution is a promising approach for reaching men and has HIV prevention potential. Clinical Trial Number: NCT03135067.
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a qualitative study of secondary distribution of hiv Self test kits by female sex workers in kenya
PLOS ONE, 2017Co-Authors: Suzanne Maman, Kawango Agot, Katherine R Murray, Sue Napierala Mavedzenge, Lennah Oluoch, Florence Sijenje, Harsha ThirumurthyAbstract:Promoting awareness of serostatus and frequent HIV testing is especially important among high risk populations such as female sex workers (FSW) and their sexual partners. HIV Self-testing is an approach that is gaining ground in sub-Saharan Africa as a strategy to increase knowledge of HIV status and promote safer sexual decisions. However, little is known about Self-test distribution strategies that are optimal for increasing testing access among hard-to-reach and high risk individuals. We conducted a qualitative study with 18 FSW who participated in a larger study that provided them with five oral fluid-based Self-Tests, training on how to use the Tests, and encouragement to offer the Self-Tests to their sexual partners using their discretion. Women demonstrated agency in the strategies they used to introduce Self-Tests to their partners and to avoid conflict with partners. They carefully considered with whom to share Self-Tests, often assessing the possibility for negative reactions from partners as part of their decision making process. When women faced negative reactions from partners, they drew on strategies they had used before to avoid conflict and physical harm from partners, such as not responding to angry partners and forgoing payment to leave angry partners quickly. Some women also used Self-Tests to make more informed sexual decisions with their partners.
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promoting partner testing and couples testing through secondary distribution of hiv Self Tests a randomized clinical trial
PLOS Medicine, 2016Co-Authors: Samuel H Masters, Suzanne Maman, Kawango Agot, Sue Napierala Mavedzenge, Beatrice Obonyo, Harsha ThirumurthyAbstract:Background Achieving higher rates of partner HIV testing and couples testing among pregnant and postpartum women in sub-Saharan Africa is essential for the success of combination HIV prevention, including the prevention of mother-to-child transmission. We aimed to determine whether providing multiple HIV Self-Tests to pregnant and postpartum women for secondary distribution is more effective at promoting partner testing and couples testing than conventional strategies based on invitations to clinic-based testing. Methods and Findings We conducted a randomized trial in Kisumu, Kenya, between June 11, 2015, and January 15, 2016. Six hundred antenatal and postpartum women aged 18–39 y were randomized to an HIV Self-testing (HIVST) group or a comparison group. Participants in the HIVST group were given two oral-fluid-based HIV test kits, instructed on how to use them, and encouraged to distribute a test kit to their male partner or use both kits for testing as a couple. Participants in the comparison group were given an invitation card for clinic-based HIV testing and encouraged to distribute the card to their male partner, a routine practice in many health clinics. The primary outcome was partner testing within 3 mo of enrollment. Among 570 participants analyzed, partner HIV testing was more likely in the HIVST group (90.8%, 258/284) than the comparison group (51.7%, 148/286; difference = 39.1%, 95% CI 32.4% to 45.8%, p < 0.001). Couples testing was also more likely in the HIVST group than the comparison group (75.4% versus 33.2%, difference = 42.1%, 95% CI 34.7% to 49.6%, p < 0.001). No participants reported intimate partner violence due to HIV testing. This study was limited by Self-reported outcomes, a common limitation in many studies involving HIVST due to the private manner in which Self-Tests are meant to be used. Conclusions Provision of multiple HIV Self-Tests to women seeking antenatal and postpartum care was successful in promoting partner testing and couples testing. This approach warrants further consideration as countries develop HIVST policies and seek new ways to increase awareness of HIV status among men and promote couples testing. Trial Registration ClinicalTrials.gov NCT02386215.
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promoting male partner hiv testing and safer sexual decision making through secondary distribution of Self Tests by hiv negative female sex workers and women receiving antenatal and post partum care in kenya a cohort study
The Lancet HIV, 2016Co-Authors: Harsha Thirumurthy, Suzanne Maman, Sue Napierala Mavedzenge, Samuel H Masters, Eunice Omanga, Kawango AgotAbstract:Summary Background Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple Self-Tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making. Methods In this cohort study, HIV-negative women aged 18–39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV Tests. Participants enrolled at the health facility received three Self-Tests and those at the drop-in centre received five Self-Tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how Self-Tests were used. Outcomes included the number of Self-Tests distributed by participants, the proportion of participants whose sexual partners used a Self-test, couples testing, and sexual behaviour after Self-testing. Findings Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed Self-Tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one Self-test to commercial sex clients. Among Self-Tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among Tests received by primary and non-primary sexual partners, two (4%) of 53 Tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p Interpretation Provision of multiple HIV Self-Tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop Self-testing policies and programmes. Funding Bill & Melinda Gates Foundation.
Anna Daunt - One of the best experts on this subject based on the ideXlab platform.
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clinical and laboratory evaluation of sars cov 2 lateral flow assays for use in a national covid 19 seroprevalence survey
Thorax, 2020Co-Authors: Barnaby Flower, Jonathan Brown, Bryony Simmons, Maya Moshe, Rebecca Frise, Rebecca Penn, Ruthiran Kugathasan, Claire Petersen, Anna DauntAbstract:Background Accurate antibody Tests are essential to monitor the SARS-CoV-2 pandemic. Lateral flow immunoassays (LFIAs) can deliver testing at scale. However, reported performance varies, and sensitivity analyses have generally been conducted on serum from hospitalised patients. For use in community testing, evaluation of finger-prick Self-Tests, in non-hospitalised individuals, is required. Methods Sensitivity analysis was conducted on 276 non-hospitalised participants. All had tested positive for SARS-CoV-2 by reverse transcription PCR and were ≥21 days from symptom onset. In phase I, we evaluated five LFIAs in clinic (with finger prick) and laboratory (with blood and sera) in comparison to (1) PCR-confirmed infection and (2) presence of SARS-CoV-2 antibodies on two ‘in-house’ ELISAs. Specificity analysis was performed on 500 prepandemic sera. In phase II, six additional LFIAs were assessed with serum. Findings 95% (95% CI 92.2% to 97.3%) of the infected cohort had detectable antibodies on at least one ELISA. LFIA sensitivity was variable, but significantly inferior to ELISA in 8 out of 11 assessed. Of LFIAs assessed in both clinic and laboratory, finger-prick Self-test sensitivity varied from 21% to 92% versus PCR-confirmed cases and from 22% to 96% versus composite ELISA positives. Concordance between finger-prick and serum testing was at best moderate (kappa 0.56) and, at worst, slight (kappa 0.13). All LFIAs had high specificity (97.2%–99.8%). Interpretation LFIA sensitivity and sample concordance is variable, highlighting the importance of evaluations in setting of intended use. This rigorous approach to LFIA evaluation identified a test with high specificity (98.6% (95%CI 97.1% to 99.4%)), moderate sensitivity (84.4% with finger prick (95% CI 70.5% to 93.5%)) and moderate concordance, suitable for seroprevalence surveys.
Sue Napierala Mavedzenge - One of the best experts on this subject based on the ideXlab platform.
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a qualitative study of secondary distribution of hiv Self test kits by female sex workers in kenya
PLOS ONE, 2017Co-Authors: Suzanne Maman, Kawango Agot, Katherine R Murray, Sue Napierala Mavedzenge, Lennah Oluoch, Florence Sijenje, Harsha ThirumurthyAbstract:Promoting awareness of serostatus and frequent HIV testing is especially important among high risk populations such as female sex workers (FSW) and their sexual partners. HIV Self-testing is an approach that is gaining ground in sub-Saharan Africa as a strategy to increase knowledge of HIV status and promote safer sexual decisions. However, little is known about Self-test distribution strategies that are optimal for increasing testing access among hard-to-reach and high risk individuals. We conducted a qualitative study with 18 FSW who participated in a larger study that provided them with five oral fluid-based Self-Tests, training on how to use the Tests, and encouragement to offer the Self-Tests to their sexual partners using their discretion. Women demonstrated agency in the strategies they used to introduce Self-Tests to their partners and to avoid conflict with partners. They carefully considered with whom to share Self-Tests, often assessing the possibility for negative reactions from partners as part of their decision making process. When women faced negative reactions from partners, they drew on strategies they had used before to avoid conflict and physical harm from partners, such as not responding to angry partners and forgoing payment to leave angry partners quickly. Some women also used Self-Tests to make more informed sexual decisions with their partners.
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promoting partner testing and couples testing through secondary distribution of hiv Self Tests a randomized clinical trial
PLOS Medicine, 2016Co-Authors: Samuel H Masters, Suzanne Maman, Kawango Agot, Sue Napierala Mavedzenge, Beatrice Obonyo, Harsha ThirumurthyAbstract:Background Achieving higher rates of partner HIV testing and couples testing among pregnant and postpartum women in sub-Saharan Africa is essential for the success of combination HIV prevention, including the prevention of mother-to-child transmission. We aimed to determine whether providing multiple HIV Self-Tests to pregnant and postpartum women for secondary distribution is more effective at promoting partner testing and couples testing than conventional strategies based on invitations to clinic-based testing. Methods and Findings We conducted a randomized trial in Kisumu, Kenya, between June 11, 2015, and January 15, 2016. Six hundred antenatal and postpartum women aged 18–39 y were randomized to an HIV Self-testing (HIVST) group or a comparison group. Participants in the HIVST group were given two oral-fluid-based HIV test kits, instructed on how to use them, and encouraged to distribute a test kit to their male partner or use both kits for testing as a couple. Participants in the comparison group were given an invitation card for clinic-based HIV testing and encouraged to distribute the card to their male partner, a routine practice in many health clinics. The primary outcome was partner testing within 3 mo of enrollment. Among 570 participants analyzed, partner HIV testing was more likely in the HIVST group (90.8%, 258/284) than the comparison group (51.7%, 148/286; difference = 39.1%, 95% CI 32.4% to 45.8%, p < 0.001). Couples testing was also more likely in the HIVST group than the comparison group (75.4% versus 33.2%, difference = 42.1%, 95% CI 34.7% to 49.6%, p < 0.001). No participants reported intimate partner violence due to HIV testing. This study was limited by Self-reported outcomes, a common limitation in many studies involving HIVST due to the private manner in which Self-Tests are meant to be used. Conclusions Provision of multiple HIV Self-Tests to women seeking antenatal and postpartum care was successful in promoting partner testing and couples testing. This approach warrants further consideration as countries develop HIVST policies and seek new ways to increase awareness of HIV status among men and promote couples testing. Trial Registration ClinicalTrials.gov NCT02386215.
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promoting male partner hiv testing and safer sexual decision making through secondary distribution of Self Tests by hiv negative female sex workers and women receiving antenatal and post partum care in kenya a cohort study
The Lancet HIV, 2016Co-Authors: Harsha Thirumurthy, Suzanne Maman, Sue Napierala Mavedzenge, Samuel H Masters, Eunice Omanga, Kawango AgotAbstract:Summary Background Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple Self-Tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making. Methods In this cohort study, HIV-negative women aged 18–39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV Tests. Participants enrolled at the health facility received three Self-Tests and those at the drop-in centre received five Self-Tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how Self-Tests were used. Outcomes included the number of Self-Tests distributed by participants, the proportion of participants whose sexual partners used a Self-test, couples testing, and sexual behaviour after Self-testing. Findings Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed Self-Tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one Self-test to commercial sex clients. Among Self-Tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among Tests received by primary and non-primary sexual partners, two (4%) of 53 Tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p Interpretation Provision of multiple HIV Self-Tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop Self-testing policies and programmes. Funding Bill & Melinda Gates Foundation.
