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Use of HIV Self-Test Kits to Increase Identification of HIV-Infected Individuals and Their Partners

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03271307
Recruitment Status : Completed
First Posted : September 5, 2017
Results First Posted : December 2, 2020
Last Update Posted : December 2, 2020
Sponsor:
Collaborators:
Partners in Hope
United States Agency for International Development (USAID)
Right to Care
Ministry of Health, Malawi
Information provided by (Responsible Party):
Kathryn L. Dovel, PhD, University of California, Los Angeles

Study Description
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Brief Summary:

This study comprises two trials to evaluate the feasibility and cost-effectiveness of HIV self-testing strategies compared to standard of care among clients in outpatient departments (OPD; Aim 1) and the sexual partners of HIV-positive clients (index testing; Aim 2).

Aim 1 will be a cluster-randomized trial in 15 clusters (high-burden health facilities) in Malawi. We will enroll 6,000 adult OPD clients (15 years or older) to test the feasibility and cost-effectiveness of facility-based HIV self-testing (HIVST) for OPD clients.

Aim 2 will be an individually-randomized trial in 3 high-burden health facilities in Malawi. We will enroll 500 adult HIV-positive clients (15 years or older) to test the feasibility and cost-effectiveness of index HIVST among partners of HIV-positive clients.


Condition or disease Intervention/treatment Phase
HIV Infections Behavioral: Optimized PITC Diagnostic Test: Facility HIVST Diagnostic Test: Index HIVST Not Applicable

Detailed Description:

The study includes two unblinded trials to evaluate the feasibility and cost-effectiveness of HIVST strategies among adults in Malawi.

Aim 1 will test the feasibility and cost-effectiveness of facility-based HIVST in OPD sites in Malawi. It will be an unblinded cluster-randomized trial and include three arms: 1) standard of care for provider-initiated testing and counseling (PITC); (2) optimized standard of care for PITC; and (3) facility-based HIVST while clients wait for routine OPD services. The standard of care arm will receive no intervention. The optimized standard of care arm will receive training and support for implementing the Malawi guidelines for PITC and morning testing. OPD clients in the facility HIVST arm will receive a HIVST demonstration and distribution, followed by uses of HIVST and private spaces for kit interpretation before receiving routine OPD services. Participants may present their self-test results to their provider, who will refer them for confirmatory HIV testing and routine ART initiation (if positive). That same day, participants from all arms will complete a brief survey upon exiting the clinic. Survey and medical record data will be compared across arms to determine whether facility HIVST is superior in regard to number of individuals tested for HIV, cost-effectiveness, number of HIV-positive individuals identified, and linkage rates for those who identify as HIV-positive.

Aim 2 will test the feasibility and cost-effectiveness of index HIVST for the sexual partners of HIV-positive clients. It will be an unblinded individually-randomized trial and include two arms: 1) standard of care partner referral slips for testing; and 2) HIVST. The standard of care arm will receive no intervention for partner notification and referral. HIV-positive clients in the HIVST arm will receive a HIVST demonstration and distribution, with instructions to give the HIVST kit to their sexual partner. Participants will be given one HIVST for each of their sexual partners who has an unknown HIV status or who tested HIV-negative more than six months prior (up to 3 HIVST kits distributed). Participants (index clients) will be given instructions on how their partner can complete the self-test and how to refer their partner(s) to care if they receive a positive result from the self-test. All participants (standard of care and HIVST arms) will complete a brief survey at the beginning of the intervention and a 4-week follow-up survey to assess primary and secondary outcomes. Medical chart reviews will be conducted for all partners reported to test HIV-positive in order to assess ART initiation rates. Survey and medical record data will be compared across arms to determine whether index HIVST is superior in regard to number of partners tested for HIV, cost-effectiveness, number of HIV-positive individuals identified, and linkage rates for those who identify as HIV-positive.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6369 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The study will include two arms and methodology: (Aim 1) A cluster-randomized trial comparing HIV testing strategies for OPD clients, clustered by health facility; and (Aim 2) A individual-randomized trial comparing HIV testing strategies for partners of HIV-positive clients.
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Use of HIV Self-Test Kits to Increase Identification of HIV-Infected Individuals and Their Partners
Actual Study Start Date : September 25, 2017
Actual Primary Completion Date : June 13, 2018
Actual Study Completion Date : January 25, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arms and Interventions
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Arm Intervention/treatment
No Intervention: AIm 1: Standard of care
Facilities assigned to the standard of care arm will receive no intervention and will continue with Ministry of Health National HIV Guidelines for provider-initiated testing and counseling (PITC) for outpatients in Aim 1. PITC guidelines recommend providers inform their OPD clients about HIV testing and refer them to HIV testing services at the facility.
Experimental: Aim 1: Optimized standard of care
Facilities assigned to the optimized standard of care arm will receive additional guidance and support from the study team to adopt the Ministry of Health National HIV Guidelines for provider-initiated testing and counseling (PITC) for Aim 1.
 Behavioral: Optimized PITC
Providers will receive training on the importance of HIV testing and their role in testing as part of OPD care and morning HIV testing will be offered. Providers will receive job aids on the importance of referring patients for HIV testing, and the study team will conduct regular monitoring and evaluation on PITC implementation.
Other Name: Optimized standard of care
Experimental: Aim 1: Facility HIVST
Facilities assigned to the HIVST arm will implement HIVST procedures in lieu of recommendations provided by the Ministry of Health National HIV Guidelines (PITC).
 Diagnostic Test: Facility HIVST
HIVST will be carried out in a group setting among patients in the waiting area of OPD clinics. Eligible clients will receive education about HIV testing and a demonstration of how to use and interpret results of a self-test kit will occur in the group setting. Participants will use the HIVST kit in a group setting and will be given private settings (private room or booth) to interpret their results. Participants will disclose their results to their OPD provider if they choose. Routine linkage to confirmatory testing and ART initiation will be conducted.
No Intervention: Aim 2: Standard of care
Facilities assigned to the standard of care arm will receive no intervention and will continue with Ministry of Health National HIV Guidelines for index HIV testing for sexual partners of HIV-positive clients. Partner referral slips will be given to HIV-positive clients to encourage partner testing.
Experimental: Aim 2: Index HIVST
Facilities assigned to the HIVST arm will implement HIVST procedures in lieu of recommendations provided by the Ministry of Health National HIV Guidelines (partner referral slips).
 Diagnostic Test: Index HIVST
HIVST demonstration and distribution will be provided to HIV-positive clients in participating facilities to distribute to their partners. Partners who have a reactive HIVST test result, or are unable or unwilling to use HIVST, will be asked to present at the health facility for routine HIV testing. Routine linkage to confirmatory testing and ART initiation will be conducted.


Outcome Measures
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Primary Outcome Measures :
  1. Aim 1: Proportion of Adult OPD Clients Tested for HIV [ Time Frame: 1 day ]
    Same day HIV testing among OPD clients, measured by self-reports from OPD clients

  2. Aim 2: Proportion of Sexual Partners Tested for HIV [ Time Frame: 4-weeks ]
    HIV testing among sexual partners of HIV-positive clients within 4-weeks of study enrollment, measured by secondary reports from HIV-positive clients


Secondary Outcome Measures :
  1. Aim 1: HIV-positivity Rate [ Time Frame: Same 1 day as enrollment (measuring HIV testing before clients leave the OPD clinic that day) ]
    HIV-positivity rate among OPD clients, measured by self-report

  2. Aim 1: ART Initiation Among OPD Clients Tested HIV-positive [ Time Frame: 3 months ]
    ART initiation within 3-months after being identified as HIV-positive within the study, measured by medical chart reviews of all Partners in Hope supported health facilities in participating districts

  3. Aim 1: Presence of Non-serious Adverse Events [ Time Frame: as enrollment (measuring adverse events that occurred at the OPD clinic that 1 day) ]
    Presence of adverse events due to the HIV testing intervention, including coercion to test, share test results, and unwanted status disclosure, measured by self-report on the day the intervention was delivered.

  4. Aim 1: Cost Per Person Initiated ART [ Time Frame: 3 months ]
    Total cost per arm (including human resources, testing, training, equipment, facility over head, staff, and testing supplies) / total number of individual initiated ART by each arm, respectively. All costs in 2017 US$. Cost calculations do not include cost of ART. Cost data in each study group were derived from a health care perspective using micro-costing methods using the HIV Counselling and Testing costing tool developed by the Health Economics and Epidemiology Research Office in South Africa. All costs are reported in 2017 US$. We use mean cost per ART initiate. Standard deviation is not included due to the nature of calculating a 'production cost'- or the total cost incurred per the respective number of outcomes.

  5. Aim 2: HIV-positivity Rates Among Sexual Partners Tested for HIV [ Time Frame: 4-weeks ]
    HIV-positivity rate measured by secondary report by the HIV-positive client

  6. Aim 2: ART Initiation Among Sexual Partners Tested HIV-positive [ Time Frame: 3 months ]
    ART initiation within 3-months after being identified as HIV-positive within the study, measured by medical chart reviews of all Partners in Hope supported health facilities in participating districts

  7. Aim 2: Presence of Non-serious Adverse Events [ Time Frame: 4-weeks ]
    Presence of adverse events due to the HIV testing intervention, including coercion to test, share test results, unwanted status disclosure, and interpersonal violence measured by self-report by the HIV-positive client

  8. Aim 2: Cost Per Person Tested HIV-Positive [ Time Frame: 1 month ]
    Total cost per arm (including human resources, testing, training, equipment, facility over head, staff, and testing supplies) / total number of individual tested HIV-positive by each arm, respectively. All costs in 2017 US$. Cost calculations include all costs associated with HIV testing. Cost data in each study group were derived from a health care perspective using micro-costing methods using the HIV Counselling and Testing costing tool developed by the Health Economics and Epidemiology Research Office in South Africa. All costs are reported in 2017 US$. We use mean cost per HIV-positive individual identified. Standard deviation is not included due to the nature of calculating a 'production cost'- or the total cost incurred per the respective number of outcomes.

  9. Aim 2: Cost Per Person Initiated ART [ Time Frame: 3 month ]
    Total cost per arm (including human resources, testing, training, equipment, facility over head, staff, and testing supplies) / total number of individual initiated ART by each arm, respectively. All costs in 2017 US$. Cost calculations do not include cost of ART. Cost data in each study group were derived from a health care perspective using micro-costing methods using the HIV Counselling and Testing costing tool developed by the Health Economics and Epidemiology Research Office in South Africa. All costs are reported in 2017 US$. We use mean cost per ART initiate. Standard deviation is not included due to the nature of calculating a 'production cost'- or the total cost incurred per the respective number of outcomes.


Eligibility Criteria
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Ages Eligible for Study:   15 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • 15 years or older
  • Willing and able to provide informed consent
  • Being seen for OPD services at the time of the study (Aim 1)
  • HIV-positive (Aim 2)
  • Have at least one sex partner in the catchment area with an unknown HIV status at the time of study enrollment (Aim 2)

Exclusion Criteria:

  • Currently enrolled in the INTERVAL study
  • Guardians attending clinics with OPD clients (Aim 1)
  • History of intimate partner violence in the past 12 months (Aim 2)
  • Fear of intimate partner violence as a consequence of participating in the study (Aim 2)
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03271307


Locations
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Malawi
Partners in Hope
Lilongwe, Malawi
Sponsors and Collaborators
University of California, Los Angeles
Partners in Hope
United States Agency for International Development (USAID)
Right to Care
Ministry of Health, Malawi
Investigators
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Principal Investigator: Kathryn Dovel, PhD, MPH University of California, Los Angeles
  Study Documents (Full-Text)

Documents provided by Kathryn L. Dovel, PhD, University of California, Los Angeles:
Study Protocol and Statistical Analysis Plan  [PDF] October 11, 2017

More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Kathryn L. Dovel, PhD, Adjunct Assistant Professor, University of California, Los Angeles
ClinicalTrials.gov Identifier: NCT03271307    
Other Study ID Numbers: 17-000109
First Posted: September 5, 2017    Key Record Dates
Results First Posted: December 2, 2020
Last Update Posted: December 2, 2020
Last Verified: November 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by Kathryn L. Dovel, PhD, University of California, Los Angeles:
self-test
testing
cost-effectiveness
Additional relevant MeSH terms:
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HIV Infections
Blood-Borne Infections
Communicable Diseases
Infections
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Lentivirus Infections
 Retroviridae Infections
RNA Virus Infections
Virus Diseases
Genital Diseases
Urogenital Diseases
Immunologic Deficiency Syndromes
Immune System Diseases