Who is Reached by HIV Self-Testing? Individual Factors Associated With Self-Testing Within a Community-Based Program in Rural Malawi. (1st October 2020)

• Record Type: Journal Article
• Authors: Indravudh, Pitchaya P.; Hensen, Bernadette; Nzawa, Rebecca; Chilongosi, Richard; Nyirenda, Rose; Johnson, Cheryl C.; Hatzold, Karin; Fielding, Katherine; Corbett, Elizabeth L.; Neuman, Melissa
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 85:Number 2(2020)
• Publication Date: 2020-10-01
• Subjects: HIV self-testing -- HIV testing -- Malawi -- men -- population-based survey -- causal associations; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002412
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Introduction: HIV self-testing (HIVST) is an alternative strategy for reaching population subgroups underserved by available HIV testing services. We assessed individual factors associated with ever HIVST within a community-based program. Setting: Malawi. Methods: We conducted secondary analysis of an end line survey administered under a cluster-randomized trial of community-based distribution of HIVST kits. We estimated prevalence differences and prevalence ratios (PRs) stratified by sex for the outcome: self-reported ever HIVST. Results: Prevalence of ever HIVST was 45.0% (475/1055) among men and 40.1% (584/1456) among women. Age was associated with ever HIVST in both men and women, with evidence of a strong declining trend across categories of age. Compared with adults aged 25–39 years, HIVST was lowest among adults aged 40 years and older for both men [34.4%, 121/352; PR 0.74, 95% confidence interval (CI): 0.62 to 0.88] and women (30.0%, 136/454; PR 0.71, 95% CI: 0.6 to 0.84). Women who were married, had children, had higher levels of education, or were wealthier were more likely to self-test. Men who had condomless sex in the past 3 months (47.9%, 279/582) reported a higher HIVST prevalence compared with men who did not have recent condomless sex (43.1%, 94/218; adjusted PR 1.37, 95% CI: 1.06 to 1.76). Among men and women, the level of previous exposure to HIV testing and household HIVST uptake was associated with HIVST. Conclusions: Community-based HIVST reached men, younger age groups, and some at-risk individuals. HIVST was lowest among older adults and individuals with less previous exposure to HIV testing, suggesting the presence of ongoing barriers to HIV testing. Abstract : Supplemental Digital Content is Available in the Text.