Is it possible to recruit HIV self-test users for an anonymous phone-based survey using passive recruitment without financial incentives? Lessons learned from a pilot study in Côte d’Ivoire

Background Due to the discreet and private nature of HIV self-testing (HIVST), it is particularly challenging to monitor and assess the impacts of this testing strategy. To overcome this challenge, we conducted a study in Côte d’Ivoire to characterize the profile of end users of HIVST kits distributed through the ATLAS project (AutoTest VIH, Libre d’Accéder à la connaissance de son Statut). Feasibility was assessed using a pilot phone-based survey. Methods The ATLAS project aims to distribute 221300 HIVST kits in Côte d’Ivoire from 2019 to 2021 through both primary (e.g., direct distribution to primary users) and secondary distribution (e.g., for partner testing). The pilot survey used a passive recruitment strategy—whereby participants voluntarily called a toll-free survey phone number—to enrol participants. The survey was promoted through a sticker on the HIVST instruction leaflet and hotline invitations and informal promotion by HIVST kit-dispensing agents. Importantly, participation was not financially incentivized, even though surveys focussed on key populations usually use incentives in this context. Results After a 7-month period in which 25,000 HIVST kits were distributed, only 42 questionnaires were completed. Nevertheless, the survey collected data from users receiving HIVST kits via both primary and secondary distribution (69% and 31%, respectively). Conclusion This paper provides guidance on how to improve the design of future surveys of this type. It discusses the need to financial incentivize participation, to reorganize the questionnaire, the importance of better informing and training stakeholders involved in the distribution of HIVST, and the use of flyers to increase the enrolment of users reached through secondary distribution.

Adolescent girls’ perception about their ability to safely offer HIV self-test kits to sexual partners: a feasibility study in Siaya County, Kenya

Background: Adolescent girls (AG) in sub-Saharan Africa are at elevated risk of acquiring HIV, yet few know the HIV status of their sexual partners. Interventions to promote testing among partners are urgently needed. Objectives: To explore AG’s perceived ability to safely distribute HIV self-tests to their partners, if partners would self-test, and how to minimize partner violence. Methods: We recruited HIV-negative AG ages 15-19 years with a partner of unknown HIV status or who tested negative >6 months previously. Using mixed-methods for data collection and regression and inductive thematic analysis for quantitative and qualitative analysis, respectively, we determined factors associated with the study objectives. Results: We enrolled 101 AG, median age 17.3 years, sexual debut 15-16 years, and 54.5% reported ≥2 lifetime partners. Most participants (95.0%) would offer self-tests to their partners and 95.1% reported high-to-moderate chance their part- ner would self-test. No participant attribute was associated with perceived ability to offer self-test or likelihood of partner testing. To avoid violence, AG recommended politeness, indirect approach, voluntariness, and highlighting advantages of self-testing. Conclusions: AG believe they can safely distribute self-tests to their partners, and most partners would self-test, expanding utility of HIV self-tests to include partners of AG. Keywords: HIV self-testing; partner testing; couples testing; adolescent girls; Kenya.

Barriers To Optimal Index Testing for Improved HIV Positivity Yield in Lusaka Urban District of Zambia - A Research Protocol

As The Proportions Of People Living With HIV Who Do Not Know Their HIV Infection Status Decrease, Reaching The Last Mile Of Those Who Are Asymptomatic And Not In Contact With The Health Care System Becomes A Critical Challenge. This Project Will Use An Explanatory Sequential Mixed-Methods Study Design. It Will Be Conducted In Three High-Volume Health Facilities In Matero Sub-District 3 Of Lusaka District In Zambia Over A Period Of One Year. The Specific Objectives Are: To Understand The Perceived Facilitators And Barriers To HIV Partner Testing From The Perspective Of The Health-Care Provider; To Propose Interventions Necessary For Improved HIV Case Finding; And To Reach High Risk But Hard To Reach Populations In HIV Programs Such As Middle-Aged Men And Adolescent Girls And Young Women (AGYW). The Permission To Conduct This Study Will Be Obtained From The Lusaka Provincial Health Office Before Its Commencement. Ethical Clearance Will Be Sought And Obtained From The ERES Converge Research Ethical Committee. The Authority To Conduct Research Will Be Sought From The National Health Research Authority. The Expected Main Findings Following The Address Of The Identified Challenges Are: Increased Number Of Recipients Of Care Indexed, Increased Index Contact Elicitation Ration From 1:1 To At Least 1:2, Improved Rate Of Contacts Tested On Time, Improved HIV Case Finding Through Index Testing, And Overall, Increased HIV Index Testing Positivity Rate From Below 25% (Baseline) To Above 40% (At The End Of The Project).

Attitudes and Perceptions About Disclosing HIV and Syphilis Results Using Smarttest, a Smartphone App Dedicated to Self- and Partner Testing

We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.