CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Further research is needed to determine barriers to confirmatory testing and linkage to care for HIV-positive self-testers.

acceptability of HIVST is necessary to achieve optimal uptake of these new testing modalities. Methods: HIVST kits were distributed to 4495 men in community-based venues in two regions in KwaZulu Natal, South Africa as part of a large implementation study. Individuals were offered self-administered oral fluid or blood-based tests and chose to use the tests on-site or at home. A subsample of 30 men who received and used HIVST kits took part in a single in-depth qualitative interview. Interviews covered: distribution of the test, experiences of HIVST, previous testing experiences, and preferences for HIV testing. Qualitative data were coded and inductively analyzed to identify themes representing men’s perspectives on and experiences using HIVST. Results: Men who participated in qualitative interviews responded positively to both types of HIVST and overwhelmingly preferred self-testing over testing at a health facility. Despite initial concerns about being able to administer the test correctly on their own, they found the HIVST kits easy and simple to use. Lack of familiarity with HIVST and the newness of the technology fueled some doubts about test efficacy, particularly oral tests. However, men gained confidence in the accuracy of HIVST when their results confirmed prior clinic-based tests. The fear of newly discovering an HIV-positive status through HIVST was an important concern for men, but this was far outweighed by the appeal of testing alone, in private. Being able to know their results “first,” without having to trust a health care worker to protect the confidentiality of their results, was unexpectedly empowering for men. They reported that HIVST gave them a sense of independence and control over decisions about testing circumstances and disclosure. This, in turn, led them to talk about the experience of HIVST to others, generating additional interest in self-testing among their peers. Conclusion: Our findings suggest that HIVST is an acceptable testing strategy among men. Men’s perceptions of self-testing appear to evolve from an initial reluctance to an overall endorsement of HIVST through the experience of using the tests. Peer distribution of HIVST may be an effective method for scaling up HIV testing in communities where men do not test for HIV. Cyprian Mostert 1 , Trishanta Kisten 2 , Linda Sande 3 , Marc D'Elbee 3 , Mohammed Majam 1 , Vincent Zishiri 1 , Willem D. Venter 1 , Karin Hatzold 4 , Cheryl Johnson 5 , Joel M. Francis 1 , Thato Chidarikire 6 , Sharon White 2 , Fern Terris-Prestholt 3 , Gesine Meyer-Rath 7 1 Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, 2 Re- Action, Johannesburg, South Africa, 3 London School of Hygiene & Tropical Medicine, London, UK, 4 Population Services International, Harare, Zimbabwe, 5 WHO, Geneva, Switzerland, 6 South African National Department of Health, Pretoria, South Africa, 7 Health Economics and Epidemiology Research Office, Johannesburg, South Africa Background: South Africa started distributing HIV self-test (HIVST) kits in 2017 in order to close remaining gaps in achieving the first 95 of the United Nations’ 95-95-95 targets across all population groups. We analysed the ability of HIVST to reach rarely or never tested employees and the cost of distributing HIVST kits to rural workplaces compared to urban industries. Methods: Distribution was targeted to small- and medium-sized workplaces with a predominantly male workforce and low baseline HIV testing in the mining, construction, manufacturing, security, petroleum and agriculture sectors in two predominantly rural and one urban province in South Africa and included both primary distribution (to employees) and secondary distribution (for their sexual partners). We used multivariate regression of the frequency of past testing to compare the probabilities of reaching never or infrequently tested populations with primary distribution in rural vs. urban workplaces. The cost of both primary and secondary distribution was analysed from the provider perspective and included the economic cost of the kit ($2, the current ex-works cost under an agreement with the manufacturer), freight, company sensitisation and HIVST demonstration, distribution and follow-up by peer educators. Results: Between Nov. 2017 and Aug. 2018, the programme distributed 123,727 self-test kits in 2,313 companies (69% and 31% through primary and secondary distribution, resp.). The industries with the highest number of primary kits distributed were agriculture, construction, mining and petroleum in the rural provinces, and mining and construction in the urban province. Uptake was 85% across industries, and in men was twice that of women. 13% of test kits were distributed to employees who had never tested, and 38% to those who had last tested more than 12 months ago. The probability of self-test

959 ACCEPTABILITY OF HIVST DISTRIBUTION BY PREGNANT WOMEN TO MALE PARTNERS: A CLOSER LOOK Norma C. Ware 1 , Monique A.Wyatt 1 , Emily E. Pisarski 1 , Andrew Mujugira 2 , Connie L. Celum 3 1 Harvard Medical School, Boston, MA, USA, 2 Infectious Diseases Research Collaboration, Kampala, Uganda, 3 University of Washington, Seattle, WA, USA Background: Provision of HIV self-test kits (HIVST) to HIV-positive pregnant women attending antenatal care for secondary distribution to partners of unknown HIV status may increase knowledge and linkage to HIV care and prevention among African men. Research to date indicates secondary distribution of HIVST by pregnant women greatly increases partner testing, but studies have not focused on experiences of women living with HIV who distribute HIVST to their partners. Methods: The Obumu study is a randomized trial of secondary distribution of HIVST and linkage of male partners to HIV care or pre-exposure prophylaxis, compared to invitation letters as standard of care, among 500 pregnant women living with HIV in Kampala, Uganda. Women randomized to deliver HIVST to their partners are trained and given two kits to take home. Obumu includes qualitative interviews with a subset of 45 women. Interviews explore: 1) the partnered relationship; 2) HIV testing experiences; 3) discovery of HIV status; 4) experiences taking antiretroviral therapy; 5) pregnancy; 6) disclosure; 7) HIVST delivery; and 8) partner responses to HIVST. In this content analysis, qualitative data were examined inductively to characterize themes in the distribution process. Results: Women in the qualitative sample were eager to have their partners test and receptive to HIVST. However, they were apprehensive about disclosing their own HIV status to their partners, believing disclosure would result in abandonment during pregnancy, when they felt vulnerable and dependent on their partner’s support. Women were anxious to avoid the questions about HIV they feared delivering the kit would raise, and coped by: 1) delivering HIVST but misrepresenting its purpose; 2) avoiding explanations by leaving the kit –without comment -- where it would be seen; or 3) not delivering HIVST at all. When women delivered kits that were used by male partners, they often avoided discussing test results, and chose not disclose their own status when their partners asked. Women whose partners knew their HIV status delivered HIVST more easily. Conclusion: Disclosure emerges as a major barrier to HIVST distribution to male partners by Ugandan pregnant women living with HIV. Counseling and support for disclosure as part of the distribution process may help to alleviate this barrier. HIVST distribution may be different, and more challenging, for HIV positive pregnant women than for women not living with HIV. 960 "FIRST TO KNOW MY STATUS": ACCEPTABILITY OF HIV SELF-TESTING AMONG SOUTH AFRICAN MEN Monique A. Wyatt 1 , Emily E. Pisarski 1 , Adrienne E. Shapiro 2 , Kombi Sausi 3 , Alastair Van Heerden 3 , Oluwafemi A.Adeagbo 4 , Janet Seeley 5 , Connie L. Celum 2 , Ruanne V. Barnabas 2 , Norma C. Ware 1 , for the DO ART Study Team 1 Harvard Medical School, Boston, MA, USA, 2 University of Washington, Seattle, WA, USA, 3 Human Sciences Research Council, Pretoria, South Africa, 4 Africa Health Research Institute, Mtubatuba, South Africa, 5 London School of Hygiene & Tropical Medicine, London, UK Background: HIV self-testing (HIVST) is increasingly being used as a strategy to improve HIV testing coverage in sub-Saharan Africa, particularly in men, who are less likely to test for HIV in traditional health care settings. Understanding

Poster Abstracts

961 THE IMPACT AND COST OF HIV SELF-TEST DISTRIBUTION IN WORKPLACES IN SOUTH AFRICA

CROI 2020 360