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


Indravudh, Pitchaya P, Fielding, Katherine, Kumwenda, Moses K, Nzawa, Rebecca, Chilongosi, Richard, Desmond, Nicola ORCID: 0000-0002-2874-8569, Nyirenda, Rose, Johnson, Cheryl C, Baggaley, Rachel C, Hatzold, Karin et al (show 2 more authors) (2019) 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. BMC INFECTIOUS DISEASES, 19 (1). 814-.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Discussion</h4>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.<h4>Trial registration</h4>Clinicaltrials.gov registry ( NCT03541382 ) registered 30 May 2018.

Item Type: Article
Uncontrolled Keywords: HIV, HIV testing, HIV self-testing, Community-led, Community mobilisation, Adolescents, Men, Malawi
Depositing User: Symplectic Admin
Date Deposited: 06 Feb 2020 10:04
Last Modified: 19 Jan 2023 00:04
DOI: 10.1186/s12879-019-4430-4
Open Access URL: http://doi.org/10.1186/s12879-019-4430-4
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3073752
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