An HIV self-testing program in Uganda trained men who have sex with men (MSM) to distribute HIV self-tests to their social and sexual networks. The program included training on how to use the HI­­V self-test, counsel people who take the test, and link people who tested positive to HIV confirmatory testing and HIV treatment. The study found that the distribution of HIV self-tests by peers identified significantly more undiagnosed HIV cases than standard testing (5.6% vs. 2.7%) and reached more never testers and MSM who had not tested in the past six months. 

Program description

Fifteen MSM (i.e., peers) were trained in HIV self-testing procedures, including result interpretation for the OraQuick HIV test. Additionally, peers received training on the following topics:

• how to troubleshoot situations that may arise during the testing process
• how to counsel people who take the test
• confirmatory testing
• how to address any misunderstandings related to testing results
• how to link people to HIV services

Each HIV self-testing kit contained images of how to use the self-test, information on wait times for results following the test and guidance on how to interpret test results. Following the training, peers were asked to use the self-test using the instructions provided, to demonstrate that they understood the procedures.

After signing a confidentiality agreement, peers were provided with 10 HIV self-testing kits to distribute to people in their social and sexual networks. The program targeted MSM who had not tested for HIV in the previous six months.

Peers provided self-test kits to participants; however, participants were not required to test in the presence of a peer nor to disclose the results of the test to the peer. Participants who received a kit were contacted by phone or were met at testing locations one to two weeks after kit distribution to see if they had used the kit. If a person declined the HIV self-test, they were invited to discuss the reasons for their decision. 

If participants shared their tests results with the peer and the result was positive, they were linked to a local organization for confirmatory testing. If the result of the confirmatory HIV testing was positive, participants were linked to HIV services. Peers could also escort participants to confirmatory testing and HIV services if the participants disclosed their tests results to them.

The peer-distributed self-testing approach was compared with the standard of care, or “moonlight testing approach,” which involved HIV testing in the evening at MSM “hot spots” using conventional HIV testing methods.

Results

Peers distributed 150 HIV self-testing kits and 95% of the people who received a kit (143) completed a HIV self-test.

• 94% of participants were counselled (after testing) by the peer who had given them the kit or a peer at the affiliated health facility
• 61% of participants tested alone
• 39% of participants tested with the support of or presence of a peer
• 32% had never previously tested for HIV

Eight participants (5.6%) tested positive with the HIV self-test. All eight disclosed their test results to the peers and all eight were linked to care where they received confirmatory testing and initiated antiretroviral therapy.

For comparison, 147 MSM participated in the standard of care testing approach during the study period, and four previously undiagnosed HIV infections were found. A comparison of the HIV self-test and standard of care groups found a statistically significant difference in the number of MSM who tested positive for HIV in each group (5.6% and 2.7%, respectively).

What does this mean for service providers?

This study shows that the distribution of HIV self-tests is feasible and accepted by testers. These findings are similar to those of comparable studies conducted in the United Kingdom and the United States. Service providers could consider innovative ways to use HIV self-tests if they are approved for use in Canada. This can include not only ways to have peers support the distribution of HIV self-tests but also ways that peers might support the use of the self-tests and roles that peers can play in linking people who test positive to confirmatory testing and HIV treatment services.

Related resources

Task-shifting in HIV testing services – evidence review

Rapid pint-of-care HIV testing: A review of the evidence – evidence review

Peer HIV testing – case study

Reference

Okoboi S, Lazarus O, Castelnuovo B et al. Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: a pilot study. PLoS ONE. 2020;15(1):e0227741.

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