Feasibility and acceptability of a pilot, peer-led HIV self-testing intervention in a hyperendemic fishing community in rural Uganda

PLOS ONE RESEARCH ARTICLE Feasibility and acceptability of a pilot, peer-led HIV self-testing intervention in a hyperendemic fishing community in rural Uganda Joseph K. B. Matovu ID1,2*, Laura M. Bogart3, Jennifer Nakabugo1, Joseph Kagaayi4, David Serwadda1, Rhoda K. Wanyenze1, Albert I. Ko5, Ann E. Kurth5,6 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Makerere University School of Public Health, Kampala, Uganda, 2 Busitema University Faculty of Health Sciences, Mbale, Uganda, 3 RAND Corporation, Santa Monica, CA, United States of America, 4 Rakai Health Sciences Program, Kalisizo, Uganda, 5 Yale School of Public Health, New Haven, CT, United States of America, 6 Yale School of Nursing, New Haven, CT, United States of America * Abstract OPEN ACCESS Citation: Matovu JKB, Bogart LM, Nakabugo J, Kagaayi J, Serwadda D, Wanyenze RK, et al. (2020) Feasibility and acceptability of a pilot, peer-led HIV self-testing intervention in a hyperendemic fishing community in rural Uganda. PLoS ONE 15(8): e0236141. https://doi.org/10.1371/journal. pone.0236141 Editor: Joel Msafiri Francis, University of the Witwatersrand, SOUTH AFRICA Received: May 5, 2020 Accepted: June 29, 2020 Published: August 7, 2020 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0236141 Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Background Novel interventions are needed to reach young people and adult men with HIV services given the low HIV testing rates in these population sub-groups. We assessed the feasibility and acceptability of a peer-led oral HIV self-testing (HIVST) intervention in Kasensero, a hyperendemic fishing community (HIV prevalence: 37–41%) in Rakai, Uganda. Methods This study was conducted among young people (15–24 years) and adult men (25+ years) between May and August 2019. The study entailed distribution of HIVST kits by trained “peer-leaders,” who were selected from existing social networks and trained in HIVST distribution processes. Peer-leaders received up to 10 kits to distribute to eligible social network members (i.e. aged 15–24 years if young people or 25+ years if adult man, not tested in the past 3 months, and HIV-negative or of unknown HIV status at enrolment). The intervention was evaluated against the feasibility benchmark of 70% of peer-leaders distributing up to 70% of the kits that they received; and the acceptability benchmark of >80% of the respondents self-testing for HIV. Results Of 298 enrolled into the study at baseline, 56.4% (n = 168) were young people (15–24 years) and 43.6% (n = 130) were adult males (25+ years). Peer-leaders received 298 kits and distributed 296 (99.3%) kits to their social network members. Of the 282 interviewed at follow-up, 98.2% (n = 277) reported that they used the HIVST kits. HIV prevalence was 7.4% (n = 21). Of the 57.1% (n = 12) first-time HIV-positives, 100% sought confirmatory HIV PLOS ONE | https://doi.org/10.1371/journal.pone.0236141 August 7, 2020 1 / 19 PLOS ONE Funding: This work was implemented as part of JKBM’s Post-Doctoral Research Fellowship with a grant from the National Institutes of Health Fogarty International Center (NIH FIC D43TW010540; PIs: Riley LW, Barry M, Ko AI, Madhivanan P) and another grant from the Africa Research Excellence Fund (RF-1570024-F-MATOV). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Feasibility and acceptability of a peer-led HIV self-testing intervention testing and nine of the ten (90%) respondents who were confirmed as HIV-positive were linked to HIV care within 1 week of HIV diagnosis. Conclusion Our findings show that a social network-based, peer-led HIVST intervention in a hyperendemic fishing community is highly feasible and acceptable, and achieves high linkage to HIV care among newly diagnosed HIV-positive individuals. Competing interests: The authors have declared that no competing interests exist. Introduction Young people and adult men are less likely to test for HIV and to be enrolled in HIV prevention, care and treatment programs [1]. Studies show that individuals aged 15–24 years are less likely to be aware of their HIV status, to be enrolled in HIV care, and to have a suppressed viral load compared to HIV-positive persons aged 30 years or older [2, 3]. This situation is even more pronounced in fishing communities in sub-Saharan Africa, where access to HIV and other health services is usually limited due to their remote locations away from the main health facilities. In a recent paper assessing the impact of combination HIV interventions on HIV incidence in hyperendemic fishing communities in Uganda, Kagaayi et al. [4] found that linkage to HIV care among HIV-positive young men in the Kasensero fishing community increased only slightly from 3% to 28% over a six-year period (2011–2017). In another conducted in the same setting to assess HIV prevalence and uptake of HIV services among youths (15–24 Years), Mafigiri et al. [5] found a high prevalence of HIV (19.7%) amidst very low (22.4%, n = 34) linkage to HIV care among HIV-positive youth. When the analysis was stratified by sex, Mafigiri et al. [5] found low utilization of HIV testing and linkage to HIV care services among male youth (HIV testing: 37.3%; linkage to HIV care: 6.7%) compared to female youth (HIV testing: 62.7%; linkage to HIV care: 28.4%). These results are corroborated by Billioux et al. [3] who found that enrolment into HIV care among HIV-positive individuals aged 15–24 years in Rakai district was 28% lower than among older individuals aged 30–39 years. Inconvenient working hours for the highly mobile fisher-folk population coupled with limited access to health facilities largely account for the low HIV testing coverage rates among young people living in the fishing community [6, 7]. On the other hand, efforts to reach men with HIV testing and treatment programs continue to be hampered by hegemomonic masculinity norms [8–11]. Evidence from gender-related studies, particularly those that focus on masculinity and its effects on the uptake of facilitybased health services, have found that men tend to avoid going to the health facilities because of fear that they could be presumed to be weak or to have HIV–which would negatively impact their “superior” social status [8, 10]. Nyamhanga et al. [8] obser (...truncated)