Summary
A study that gave HIV self-testing kits out to 127 mainly young men who have sex with men (MSM) in two regions in north-east South Africa found that they much preferred using them than going to a clinic for a test. Of the 127 recruited, 116 (91.3%) used the self-test kit at least once and nearly half used the test twice during the six-month study period (there were three visits altogether, at baseline, month three and month six). It also found that the proportion of men who had tested for HIV in the last six months greatly increased during the follow-up period and that the proportion who anticipated testing frequently from then on also increased.
The study also asked participants to give out test kits to sexual partners and friends and most participants did so. The researchers were surprised at the high proportion of participants who gave out test kits to family members. The study provided both oral fluid and fingerprick tests and found that, in this population at least, fingerprick testing was preferred because participants trusted it more.
There were six new HIV infections diagnosed in the 127 participants. Although the study was not designed or powered to determine HIV incidence, these six infections within 55 person-years would equate to a very high annual incidence of 10.9%.
Even more impressively perhaps, there were 40 new diagnoses detected among trial participants’ contacts, among a total of 728 test kits being given out or one diagnosis per 18 test kits. As the researchers point out, given that this total was a figure reported second-hand to the researchers by participants, it is likely to represent a minimum number.
The self-testing trial was conducted in two Districts in Mpumalanga Province, Gert Sibande and Ehlanzeni. The former is rural, encompassing a cluster of farming towns on the High Veldt. The latter is urban, including Nelspruit, the Provincial Capital, which is a tourist hub for visitors to Kruger National Park.
The majority of participants (69) were re-contacted from a previous behavioural MSM survey, the 2012-2015 Mpumulanga Men’s Study. However, while 86% of those re-contacted from Gert Sibande were enrolled in the self-testing study, only a small proportion of participants in the 2015 study in Ehlanzeni could be contacted and only 44% (14 men) were enrolled. It was therefore decided to do a second wave of so-called Respondent-Driven Sampling (RDS) in Ehlanzeni. (In RDS, volunteers called ‘seeds’ from the local MSM community undertake to recruit others.) In the end 54 men and one transgender woman from Gert Sibande and 72 men from Ehlanzeni took part.