Preferences and Uptake of Home-based HIV Self-testing for Maternal Retesting in Kenya

Overview

Journal medRxiv

Date 2024 Apr 8

PMID 38585992

Authors

Alison L Drake

Wenwen Jiang

Peninah Kitao

Shiza Farid

Barbra A Richardson

David A Katz

Anjuli D Wagner

Cheryl C Johnson

Daniel Matemo

Grace-John Stewart

John Kinuthia

Affiliations

Soon will be listed here.

Abstract

Objective: To compare preferences, uptake, and cofactors for unassisted home-based oral self-testing (HB-HIVST) versus clinic-based rapid diagnostic blood tests (CB-RDT) for maternal HIV retesting.

Design: Prospective cohort.

Methods: Between November 2017 and June 2019, HIV-negative pregnant Kenyan women receiving antenatal care were enrolled and given a choice to retest with HB-HIVST or CB-RDT. Women were asked to retest between 36 weeks gestation and 1 week post-delivery if the last HIV test was <24 weeks gestation or at 6 weeks postpartum if ≥24 weeks gestation, and self-report on retesting at a 14 week postpartum.

Results: Overall, 994 women enrolled and 33% (n=330) selected HB-HIVST. HB-HIVST was selected because it was private (68%), convenient (63%), and offered flexibility in timing of retesting (63%), whereas CB-RDT was selected due to trust of providers to administer the test (77%) and convenience of clinic testing (64%). Among 905 women who reported retesting at follow-up, 135 (15%) used HB-HIVST. Most (94%) who selected CB-RDT retested with this strategy, compared to 39% who selected HB-HIVST retesting with HB-HIVST. HB-HIVST retesting was more common among women with higher household income and those who may have been unable to test during pregnancy (both retested postpartum and delivered <37 weeks gestation) and less common among women who were depressed. Most women said they would retest in the future using the test selected at enrollment (99% HB-HIVST; 93% CB-RDT-RDT).

Conclusions: While most women preferred CB-RDT for maternal retesting, HB-HIVST was acceptable and feasible and may increase retesting coverage and partner testing.

References

Figueroa C, Johnson C, Ford N, Sands A, Dalal S, Meurant R . Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis. Lancet HIV. 2018; 5(6):e277-e290. PMC: 5986793. DOI: 10.1016/S2352-3018(18)30044-4. View

Heemelaar S, Habets N, Makukula Z, van Roosmalen J, van den Akker T . Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia. Trop Med Int Health. 2014; 20(3):277-83. DOI: 10.1111/tmi.12432. View

Kinuthia J, Richardson B, Drake A, Matemo D, Unger J, McClelland R . Sexual Behavior and Vaginal Practices During Pregnancy and Postpartum: Implications for HIV Prevention Strategies. J Acquir Immune Defic Syndr. 2016; 74(2):142-149. PMC: 5357239. DOI: 10.1097/QAI.0000000000001225. View

Nungu S, Mghamba J, Rumisha S, Semali I . Uptake and determinants for HIV postpartum re-testing among mothers with prenatal negative status in Njombe region, Tanzania. BMC Infect Dis. 2019; 19(1):398. PMC: 6506942. DOI: 10.1186/s12879-019-4062-8. View

Pai N, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L . Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review. PLoS Med. 2013; 10(4):e1001414. PMC: 3614510. DOI: 10.1371/journal.pmed.1001414. View

Iliyasu Z, Galadanci H, Musa A, Iliyasu B, Nass N, Garba R . HIV self-testing and repeat testing in pregnancy and postpartum in Northern Nigeria. Trop Med Int Health. 2022; 27(1):110-119. DOI: 10.1111/tmi.13705. View

Oyaro P, Kwena Z, Bukusi E, Baeten J . Is HIV Self-Testing a Strategy to Increase Repeat Testing Among Pregnant and Postpartum Women? A Pilot Mixed Methods Study. J Acquir Immune Defic Syndr. 2020; 84(4):365-371. PMC: 7321872. DOI: 10.1097/QAI.0000000000002347. View

Meisner J, Roberts D, Rodriguez P, Sharma M, Owiredu M, Gomez B . Optimizing HIV retesting during pregnancy and postpartum in four countries: a cost-effectiveness analysis. J Int AIDS Soc. 2021; 24(4):e25686. PMC: 8010369. DOI: 10.1002/jia2.25686. View

Cox J, Holden J, Sagovsky R . Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987; 150:782-6. DOI: 10.1192/bjp.150.6.782. View

10.

Rogers A, Weke E, Kwena Z, Bukusi E, Oyaro P, Cohen C . Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study. BMC Pregnancy Childbirth. 2016; 16(1):151. PMC: 4940827. DOI: 10.1186/s12884-016-0936-6. View

11.

Jamil M, Eshun-Wilson I, Witzel T, Siegfried N, Figueroa C, Chitembo L . Examining the effects of HIV self-testing compared to standard HIV testing services in the general population: A systematic review and meta-analysis. EClinicalMedicine. 2021; 38:100991. PMC: 8271120. DOI: 10.1016/j.eclinm.2021.100991. View

12.

Pintye J, Drake A, Begnel E, Kinuthia J, Abuna F, Lagat H . Acceptability and outcomes of distributing HIV self-tests for male partner testing in Kenyan maternal and child health and family planning clinics. AIDS. 2019; 33(8):1369-1378. PMC: 6546533. DOI: 10.1097/QAD.0000000000002211. View

13.

Drake A, Wagner A, Richardson B, John-Stewart G . Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis. PLoS Med. 2014; 11(2):e1001608. PMC: 3934828. DOI: 10.1371/journal.pmed.1001608. View

14.

Penumetsa M, Neary J, Farid S, Kithao P, Richardson B, Matemo D . Implementation of HIV Retesting During Pregnancy and Postpartum in Kenya: A Cross-Sectional Study. Glob Health Sci Pract. 2022; 10(1). PMC: 8885347. DOI: 10.9745/GHSP-D-21-00451. View

15.

Eshun-Wilson I, Jamil M, Witzel T, Glidded D, Johnson C, Le Trouneau N . A Systematic Review and Network Meta-analyses to Assess the Effectiveness of Human Immunodeficiency Virus (HIV) Self-testing Distribution Strategies. Clin Infect Dis. 2021; 73(4):e1018-e1028. PMC: 8366833. DOI: 10.1093/cid/ciab029. View

16.

Masters S, Agot K, Obonyo B, Mavedzenge S, Maman S, Thirumurthy H . Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial. PLoS Med. 2016; 13(11):e1002166. PMC: 5100966. DOI: 10.1371/journal.pmed.1002166. View

17.

Mandala J, Kasonde P, Badru T, Dirks R, Torpey K . HIV Retesting of HIV-Negative Pregnant Women in the Context of Prevention of Mother-to-Child Transmission of HIV in Primary Health Centers in Rural Zambia: What Did We Learn?. J Int Assoc Provid AIDS Care. 2019; 18:2325958218823530. PMC: 6748466. DOI: 10.1177/2325958218823530. View

18.

Drake A, Thomson K, Quinn C, Owiredu M, Nuwagira I, Chitembo L . Retest and treat: a review of national HIV retesting guidelines to inform elimination of mother-to-child HIV transmission (EMTCT) efforts. J Int AIDS Soc. 2019; 22(4):e25271. PMC: 6452920. DOI: 10.1002/jia2.25271. View

19.

Rogers A, Akama E, Weke E, Blackburn J, Owino G, Bukusi E . Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities. J Int AIDS Soc. 2017; 20(4). PMC: 5810348. DOI: 10.1002/jia2.25036. View

20.

Teasdale C, Choy M, Tsiouris F, De Gusmao E, Banqueiro E, Couto A . HIV retesting for pregnant and breastfeeding women across maternal child health services in Nampula, Mozambique. PLoS One. 2023; 18(3):e0283558. PMC: 10038279. DOI: 10.1371/journal.pone.0283558. View