Factors associated with the successful distribution of HIV self-tests through routine clinical settings in Lusaka, Zambia: a cohort study


BACKGROUND: This study evaluated secondary distribution of HIV self-tests (HIVST) to reach individuals underserved by standard testing approaches.
METHODS: Individuals ('¥16 years) accessing antenatal care (ANC) or antiretroviral therapy (ART) services at two peri-urban public health facilities in Lusaka, Zambia between 11th November 2019 and 31st July 2020 were offered an HIVST kit for distribution to their partners. Interviews were conducted on the day of HIVST collection and at clinic visits 1 month later. Partners were interviewed 3 months after distribution. Logistic regression analyses assessed whether kit use was associated with characteristics of the distributor or their partner.
RESULTS: In ANC, 508 individuals accepted HIVST for distribution, of whom 457(90.0%) were re-interviewed after 1 month. At this time, successful HIVST distribution was reported by 398(87.1%) of the respondents and 342(74.8%) reported HIVST use by their partner. Of 243 male partners interviewed at 3 months, 194(79.8%) reported HIVST use, 6(3.1%) had a reactive result and 4 initiated ART. Reported use after secondary distribution was higher if this was the first pregnancy (OR=2.52, 95%CI 1.23 ' 5.18) or the partners were aged under age 35 (OR=3.61, 95%CI 1.69-7.74).
From ART clinics, 122 individuals (66.4% male) accepted HIVST kits of whom 85(69.7%) were re-interviewed at 1 month. Successful HIVST distribution was reported by 74(87.1%) respondents, with 55(64.7%) reporting HIVST use by their partner. Of 58 partners interviewed at 3 months 44(75.9 %) reported HIVST use, 9(20.5%) of these had a reactive result and 5 initiated ART.
The most common reason given for non-distribution (39/59(66.1%) in ANC and 5/11(45.5%) in ART was that the partner was elsewhere in the country.
CONCLUSIONS: Secondary HIVST distribution showed potential to reach people living with HIV (PLHIV) unaware of their status. The yield of newly identified PLHIV was higher for kits distributed from ART than in ANC clinics, although participation was lower. Further optimisation, including integration into contact ('index') testing systems may be achievable. In ANC, targeted recruitment of women in their first pregnancy may lead to higher yields. More flexible delivery methods may be needed to reach partners temporarily absent and to engage older male partners.