A pilot trial of the peer-based distribution of HIV self-test kits among fishermen in Bulisa, Uganda

RESEARCH ARTICLE A pilot trial of the peer-based distribution of HIV self-test kits among fishermen in Bulisa, Uganda Augustine T. Choko ID1,2*, Mastula Nanfuka3, Josephine Birungi3, Geoffrey Taasi4, Prossy Kisembo3, Stephane Helleringer5 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Choko AT, Nanfuka M, Birungi J, Taasi G, Kisembo P, Helleringer S (2018) A pilot trial of the peer-based distribution of HIV self-test kits among fishermen in Bulisa, Uganda. PLoS ONE 13(11): e0208191. https://doi.org/10.1371/journal. pone.0208191 Editor: Bruce A Larson, Boston University School of Public Health, UNITED STATES Received: May 16, 2018 Accepted: November 13, 2018 Published: November 29, 2018 Copyright: © 2018 Choko et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was supported by: Stephane Helleringer, Funder: National Institutes of Health (NIH), Grant number: 5R21AI127286-02; Augustine Choko, Funder: Wellcome Trust, UK, Grant number: 105828/Z/14/Z. The funder had no role in the design, data collection, analysis and decision to publish the results. 1 Malawi- Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi, 2 Dept. of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom, 3 The AIDS Support Organisation (TASO), Kampala, Uganda, 4 Ministry of Health, Kampala, Uganda, 5 John Hopkins University, Baltimore, Maryland, United States of America * Abstract Background HIV self-testing (HIVST) addresses barriers to HIV diagnosis among men, but current approaches to distributing HIVST kits only reach a subset of the men requiring testing. Methods We conducted a pilot trial of the secondary distribution of HIVST kits through peer networks in fishing communities of Buliisa district (Uganda). We recruited distributors (“seeds”) among male patients of a health facility, and among community members. Seeds were trained in HIVST and asked to distribute up to five kits to their peers (“recruits”). Recruits were referred to the study using a coupon, and asked to return the HIVST kit (used or unused). The accuracy of HIVST was measured against a confirmatory test conducted by a health worker. We conducted audio computer assisted self-interviews to measure the occurrence of adverse events, and evaluate the potential yield of peer-delivered HIVST. We also assessed how seeds and recruits rated their experience with peer-distributed HIVST. Results Nineteen seeds offered an HIVST kit to 116 men, and 95 (81.9%) accepted the offer. No recruit reported coercion, but two seeds experienced hostility from recruits or their family members. The sensitivity of peer-distributed HIVST, as interpreted by recruits, was 100%, and its specificity was 92.8%. Among recruits, 29 had never tested (25.8%), and 42 (44.2%) had tested more than a year ago. Three men living with HIV learned their status through peer-distributed HIVST (yield = 1 new diagnosis per 6.3 seeds). Most recruits (85/88) and seeds (19/19) reported that they would recommend HIVST to their friends and family. All seeds stated that they would accept acting as peer distributors again. PLOS ONE | https://doi.org/10.1371/journal.pone.0208191 November 29, 2018 1 / 12 Uptake of HIV self-testing among fishermen Competing interests: The authors have declared that no competing interests exist. Conclusions This novel peer-based distribution model of HIVST is safe, and has high uptake. It could help reduce the gender gap in HIV testing in under-served fishing communities in Uganda and elsewhere. Introduction Significant numbers of persons living with HIV remain undiagnosed in African countries [1]. To end the HIV/AIDS epidemic by 2030, new HIV testing strategies must be explored. In particular, strategies that reach men living with HIV (MLWH) are needed [2], since MLWH are less likely to use existing testing services than women [3–5]. Novel HIV testing strategies may contribute to ending the HIV/AIDS epidemic by reaching hard to reach groups that continue to contribute to gaps in HIV status knowledge as well as being drivers of HIV transmission. One potential strategy is HIV self-testing (HIVST), i.e., an individual performing his/her own HIV test [6–10]. HIVST is accurate, convenient and confidential [6, 11–13]. It may foster repeat testing [7], but strategies to reach undiagnosed MLWH with HIVST remain underdeveloped. Current models include distributing HIVST kits at health facilities, or during home visits by health workers [6]. These approaches may miss MLWH who seldom attend health facilities, or who are absent from home for work-related or other reasons. Thus, alternate distribution mechanisms for HIV self-testing targeting MLWH need to be explored. Several studies have also investigated the secondary distribution of HIVST kits. In this model, some individuals are given kits to distribute to members of their social networks. Most such studies have mobilized women as distributors of HIVST kits: clients of antenatal care clinics have been asked to distribute HIVST kits to their partner [14] and female sex workers (FSW) have been asked to enroll their male clients [14, 15]. Despite being safe and effective, these approaches only reach a subset of the MLWH who require testing. We recruited men as distributors (or “seeds”), and asked them to offer HIVST kits to their peers. This approach has been used among men who have sex with men [16], but not in other high-risk groups of men. Potential concerns include an increased incidence of coerced testing [17]. We thus measured the safety, uptake and potential yield of this strategy in several fishing communities in Uganda. Methods We conducted a single-arm pilot trial of the peer-based distribution of HIVST kits in 4 fishing communities of Buliisa district, on the shores of Lake Albert. As in other fishing communities in Uganda [18], HIV risk is high, but HIV testing is limited [11]. The institutional review boards of Johns Hopkins University, the AIDS Support organization and the Uganda National Council for Science and Technology approved the study. We translated materials detailing HIVST procedures into the local language (Runyoro). We developed standardized scripts (S1 ScriptEng) to help men 1) introduce HIVST to peers, 2) address misunderstandings and 3) troubleshoot conflictual situations that may arise during the distribution of HIVST kits. We then recruited seeds among a) patients receiving antiretroviral treatment at a local facility of the AIDS Support Organization (TASO), b) clients of other services (e.g., HIV testing and counseling) or c) community members. Seeds had to be (...truncated)