Offering Self-administered Oral HIV Testing as a Choice to Truck Drivers in Kenya: Predictors of Uptake and Need for Guidance While Self-testing (pdf)

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Offering Self-administered Oral HIV Testing as a Choice to Truck Drivers in Kenya: Predictors of Uptake and Need for Guidance While Self-testing

AIDS Behav DOI 10.1007/s10461-017-1783-9 ORIGINAL PAPER Offering Self-administered Oral HIV Testing as a Choice to Truck Drivers in Kenya: Predictors of Uptake and Need for Guidance While Self-testing Elizabeth A. Kelvin1 • Gavin George2 • Eva Mwai3 • Eston N. Nyaga3 • Joanne E. Mantell4 • Matthew L. Romo1 • Jacob O. Odhiambo3 • Kaymarlin Govender2 Ó The Author(s) 2017. This article is an open access publication Abstract We assessed predictors of choosing self-administered oral HIV testing in the clinic with supervision versus the standard provider-administered blood test when offered the choice among 149 Kenyan truck drivers, described the types of guidance participants needed during self-testing and predictors of needing guidance. Overall, 56.38% of participants chose the self-test, 23.49% the provider-administered test, and 20.13% refused testing. In the adjusted regression models, each additional unit on the fatalism and self-efficacy scales was associated with 0.97 (p = 0.003) and 0.83 (p = 0.008) times lower odds of choosing the self-test, respectively. Overall, 52.38% of self-testers did so correctly without questions, 47.61% asked questions, and 13.10% required unsolicited correction from the provider. Each additional unit on the fatalism scale was associated with 1.07 times higher odds of asking for guidance when self-testing (p \ 0.001). Self-administered oral HIV testing seems to be acceptable and feasible among Kenyan truck drivers, especially if given the opportunity to ask questions. & Elizabeth A. Kelvin 1 2 Department of Epidemiology and Biostatistics and Institute for Implementation Scince in Population Health, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, NY 10027, USA Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa 3 North Star Alliance, Nairobi, Kenya 4 Division of Gender, Sexuality and Health, Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute & Columbia University Medical Center, New York, NY, USA Resumen Evaluamos los factores predictores de elegir de la prueba oral de VIH autoadministrada en la clı́nica con supervisión versus la prueba estándar de sangre administrada por el proveedor cuando se les ofreció la elección entre 149 conductores de camiones en Kenia; también describimos la ayuda que los participantes necesitaron durante la autoadministración y predictores de necesitar ayuda. En total, el 56,38% de los participantes optó por la prueba autoadministrada, el 23,49% optó por la prueba administrada por el proveedor, y 20,13% rehusó hacer la prueba. En los modelos de regresión ajustados, cada unidad adicional en las escalas de fatalismo y autoeficacia se asoció con 0,97 (p = 0,003) y 0,83 (p = 0,008) veces menos Probabilidad de elegir la prueba autoadministrada, respectivamente. En total, el 52,38% de los participantes autoadministradores hizo la prueba correctamente sin tener preguntas, el 47,61% hizo preguntas y el 13,10% necesitaba corrección por el proveedor no solicitada por parte del participante. Cada unidad adicional en la escala de fatalismo se asoció con 1,07 veces mayores probabilidad de hacer preguntas entre los participantes autoadministradores (p \ 0,001). La prueba oral de VIH autoadministrada parece ser aceptable y factible entre los conductores de camiones en Kenia, especialmente si se les da la oportunidad de hacer preguntas. Keywords Diagnostic tests HIV HIV testing Kenya Introduction In 2014, the Joint United Nations Programme on HIV and AIDS (UNAIDS) launched its ambitious 90-90-90 HIV testing and treatment goals that by 2020, 90% of people living with HIV will know their HIV status, 90% of people 123 AIDS Behav diagnosed with HIV will receive sustained antiretroviral therapy, and 90% of people receiving antiretroviral therapy will have viral suppression [1]. A key motivation for these goals is the finding that treatment as prevention is effective in decreasing HIV incidence [2], and the World Health Organization (WHO) has recommended that all people living with HIV, regardless of CD4? T cell count, should initiate treatment immediately for improved health and to decrease the probability of transmission to others [3]. However, HIV testing rates in many countries remain suboptimal, and in Kenya 2012–2013, only a little over half of those age 15–64 had tested in the past year and 53% of those HIV-infected were unaware of their HIV status [4]. New HIV testing strategies will likely be needed in order to reach the 90-90-90 goals Truck drivers in Africa have been characterized as a key population to target for HIV prevention, testing and treatment services due to their high HIV risk and unmet need for services [5–7], and because they can be a conduit for the spread of HIV between female sex workers (FSWs) and other partners and across international borders due to workrelated travel [6, 8]. Health clinics targeting truck drivers now appear along many major trucking routes [9–11], but the few available studies suggest that testing uptake in this population remains low. A 2003–2004 survey of 1896 long-distance truck drivers in South Africa found that only 38.2% had ever been tested for HIV [12]. In a 2009 study in a night clinic at a truck stop in northern Mozambique, only a quarter of participants accepted HIV testing when offered and, of those, 27% tested HIV? [10]. A 2010 study among long distance truck drivers in Togo found 47.4% had ever tested for HIV [13]. In 2012, the North Star Alliance, an organization that runs 35 roadside wellness clinics providing services to truck drivers on major transit routes in Africa, reported only about 21% of 219,681 client-visits included HIV testing despite the fact that testing is offered at every visit [14]. Trucking Wellness, which runs 22 roadside clinics for truck drivers in South Africa, reported that only about 10% of the [90,000 clients seen in 2012 were tested for HIV, of which 7% were found to be HIV? [15]. Thus, despite the convenience of roadside health facilities, demand for HIV testing remains low, suggesting that barriers persist. On July 3, 2012, the United States (US) Food and Drug Administration (FDA) approved a rapid self-administered oral HIV test for at-home use (OraQuick In-Home HIV Test) [16]. This test can be used in or outside of a clinic setting, and has the potential to reduce a number of barriers to HIV testing faced by truck drivers, therefore potentially providing a more acceptable option for people in mobile professions who do not use existing HIV testing and counseling services. The ability to self-test at home or in private may allay concerns about the stigma of being seen 123 at the clinic and possible breach of confidentiality, barriers often cited [17–20]. Self-administered testing in a clinic setting may also reduce the burden on he (...truncated)