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- Title
Community-led delivery of HIV self-testing to improve HIV testing, ART initiation and broader social outcomes in rural Malawi: study protocol for a cluster-randomised trial.
- Authors
Indravudh, Pitchaya P.; Fielding, Katherine; Kumwenda, Moses K.; Nzawa, Rebecca; Chilongosi, Richard; Desmond, Nicola; Nyirenda, Rose; Johnson, Cheryl C.; Baggaley, Rachel C.; Hatzold, Karin; Terris-Prestholt, Fern; Corbett, Elizabeth L.
- Abstract
<bold>Background: </bold>Prevention of new HIV infections is a critical public health issue. The highest HIV testing gaps are in men, adolescents 15-19 years old, and adults 40 years and older. Community-based HIV testing services (HTS) can contribute to increased testing coverage and early HIV diagnosis, with HIV self-testing (HIVST) strategies showing promise. Community-based strategies, however, are resource intensive, costly and not widely implemented. A community-led approach to health interventions involves supporting communities to plan and implement solutions to improve their health. This trial aims to determine if community-led delivery of HIVST can improve HIV testing uptake, ART initiation, and broader social outcomes in rural Malawi.<bold>Methods: </bold>The trial uses a parallel arm, cluster-randomised design with group village heads (GVH) and their defined catchment areas randomised (1:1) to community-led HIVST or continue with the standard of the care (SOC). As part of the intervention, informal community health cadres are supported to plan and implement a seven-day HIVST campaign linked to HIV treatment and prevention. Approximately 12 months after the initial campaign, intervention GVHs are randomised to lead a repeat HIVST campaign. The primary outcome includes the proportion of adolescents 15-19 years old who have tested for HIV in their lifetime. Secondary outcomes include recent testing in adults 40 years and older and men; ART initiation; knowledge of HIV prevention; and HIV testing stigma. Outcomes will be measured through cross-sectional surveys and clinic registers. Economic evaluation will determine the cost per person tested, cost per person diagnosed, and incremental cost effectiveness ratio.<bold>Discussion: </bold>To the best of our knowledge, this is the first trial to assess the effectiveness of community-led HTS, which has only recently been enabled by the introduction of HIVST. Community-led delivery of HIVST is a promising new strategy for providing periodic HIV testing to support HIV prevention in rural communities. Further, introduction of HIVST through a community-led framework seems particularly apt, with control over healthcare concurrently devolved to individuals and communities.<bold>Trial Registration: </bold>Clinicaltrials.gov registry ( NCT03541382 ) registered 30 May 2018.
- Subjects
MALAWI; PRE-exposure prophylaxis; RURAL health clinics; HIV prevention; HIV; OLDER men; WATERSHEDS
- Publication
BMC Infectious Diseases, 2019, Vol 19, Issue 1, pN.PAG
- ISSN
1471-2334
- Publication type
journal article
- DOI
10.1186/s12879-019-4430-4