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HiSTEP: A Single-Arm Pilot Study of a Technology-Assisted HIV Self-testing Intervention in Kampala, Uganda

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Abstract

We developed and pilot tested a 3-month HIV self-testing intervention called HiSTEP (“HIV Self-testing Engagement Project”) among 95 adult (18+ years) at-risk (condomless sex < 3 months) adults in Kampala, Uganda. HiSTEP leverages theoretically-grounded (in the Information-Motivation-Behavioral Skills model) text messages, a telehealth centre with live support, and “last-mile” HIV self-testing kit delivery to a location chosen by the participant. Nearly 94% of participants were retained at month 3. HIV self-testing was highly acceptable across age and gender groups (94% very satisfied), although older women had slightly lower acceptability ratings (92% very satisfied). Only 13% of participants used HIV self-testing prior to enrollment. Over the 3-month study period, 86% of participants ordered a total of 169 HIV self-testing kits (69% for participant use; 31% for use by others). Findings show that the intervention approach taken in HiSTEP may be particularly valuable for engaging at-risk Ugandan adults in HIV self-testing using a novel technology-assisted promotion and delivery method.

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References

  1. UNAID. Country factsheets Uganda 2018. 2018; http://www.unaids.org/en/regionscountries/countries/uganda. Accessed 27 Aug 2020.

  2. UNAIDS. Fast track: ending the AIDS epidemic by 2030. 2014; https://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf. Accessed 27 May 2020.

  3. McNulty MC, Schneider JA. Care continuum entry interventions: seek and test strategies to engage persons most impacted by HIV within the United States. AIDS. 2018;32(4):407–17.

    Article  Google Scholar 

  4. UNAIDS. Uganda country factsheet. 2020; https://www.unaids.org/en/regionscountries/countries/uganda. Accessed 21 May 2020.

  5. McNaghten AD, Schilsky Mneimneh A, Farirai T, et al. Implementation and operational research: strengthening HIV test access and treatment uptake study (Project STATUS): a randomized trial of HIV testing and counseling interventions. J Acquir Immune Defic Syndr. 2015;70(4):e140-146.

    Article  CAS  Google Scholar 

  6. Brunie A, Wamala-Mucheri P, Akol A, Mercer S, Chen M. Expanding HIV testing and counselling into communities: feasibility, acceptability, and effects of an integrated family planning/HTC service delivery model by Village Health Teams in Uganda. Health Policy Plan. 2016;31(8):1050–7.

    Article  Google Scholar 

  7. Chamie G, Schaffer EM, Ndyabakira A, et al. Comparative effectiveness of novel nonmonetary incentives to promote HIV testing. AIDS. 2018;32(11):1443–51.

    Article  Google Scholar 

  8. Harichund C, Moshabela M. Acceptability of HIV self-testing in sub-Saharan Africa: scoping study. AIDS Behav. 2018;22(2):560–8.

    Article  Google Scholar 

  9. Spielberg F, Levine RO, Weaver M. Self-testing for HIV: a new option for HIV prevention? Lancet Infect Dis. 2004;4(10):640–6.

    Article  Google Scholar 

  10. Undanda Ministry of Health. Consolidated guidelines for the prevention and treatment of HIV and AIDS in Ugdana, second edition. 2018.

  11. Okoboi S, Lazarus O, Castelnuovo B, et al. Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: a pilot study. PLoS ONE. 2020;15(1):e0227741.

    Article  CAS  Google Scholar 

  12. Matovu JKB, Kisa R, Buregyeya E, et al. “If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV”: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda. Glob Health Action. 2018;11(1):1503784.

    Article  Google Scholar 

  13. Ortblad K, KibuukaMusoke D, Ngabirano T, et al. Direct provision versus facility collection of HIV self-tests among female sex workers in Uganda: a cluster-randomized controlled health systems trial. PLoS Med. 2017;14(11):e1002458.

    Article  Google Scholar 

  14. van Rooyen H, Tulloch O, Mukoma W, et al. What are the constraints and opportunities for HIVST scale-up in Africa? Evidence from Kenya, Malawi and South Africa. J Int AIDS Soc. 2015;18:19445.

    Article  Google Scholar 

  15. Peck RB, Lim JM, van Rooyen H, et al. What should the ideal HIV self-test look like? A usability study of test prototypes in unsupervised HIV self-testing in Kenya, Malawi, and South Africa. AIDS Behav. 2014;18(Suppl 4):S422-432.

    Article  Google Scholar 

  16. Horvath KJ, Walker T, Mireles L, Bauermeister JA, Hightow-Weidman L, Stephenson R. A systematic review of technology-assisted HIV testing interventions. Curr HIV/AIDS Rep. 2020;17(4):269–80.

    Article  Google Scholar 

  17. Kelvin EA, George G, Kinyanjui S, et al. Announcing the availability of oral HIV self-test kits via text message to increase HIV testing among hard-to-reach truckers in Kenya: a randomized controlled trial. BMC Public Health. 2019;19(1):7.

    Article  Google Scholar 

  18. Kelvin EA, George G, Mwai E, et al. A randomized controlled trial to increase HIV testing demand among female sex workers in Kenya through announcing the availability of HIV self-testing via text message. AIDS Behav. 2019;23(1):116–25.

    Article  Google Scholar 

  19. Njuguna N, Ngure K, Mugo N, et al. The effect of human immunodeficiency virus prevention and reproductive health text messages on human immunodeficiency virus testing among young women in rural Kenya: a pilot study. Sex Transm Dis. 2016;43(6):353–9.

    Article  Google Scholar 

  20. Janssen R, Engel N, Esmail A, et al. Alone but supported: a qualitative study of an HIV self-testing app in an observational cohort study in South Africa. AIDS Behav. 2020;24(2):467–74.

    Article  Google Scholar 

  21. Uganda Communications Commission. Communication sector report—September 2019. 2020; https://uccinfo.blog/2020/01/30/communication-sector-report-september-2019/. Accessed 7 May 2020.

  22. Fisher J, Fisher W. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.

    Article  CAS  Google Scholar 

  23. Fisher WA, Fisher JD, Rye BJ. Understanding and promoting AIDS-preventative behavior: insights from the theory of reasoned action. Health Psychol. 1995;14(3):255–64.

    Article  CAS  Google Scholar 

  24. Fisher J, Fisher W, Bryan A, Misovich S. Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. Health Psychol. 2002;21(2):177–86.

    Article  Google Scholar 

  25. Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the Information, Motivation and Behavioral Skills model of antiretroviral therapy adherence. AIDS Care. 2005;17(6):661–73.

    Article  CAS  Google Scholar 

  26. Uganda Bureau of Statistics. Statistica Abstract (2019). 2019; https://www.ubos.org/statistical-abstract-2019/. Accessed 5 Feb 2021.

  27. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  Google Scholar 

  28. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    Article  Google Scholar 

  29. Carey MP, Schroder KE. Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Educ Prev. 2002;14(2):172–82.

    Article  Google Scholar 

  30. Lippman SA, Lane T, Rabede O, et al. High acceptability and increased HIV-testing frequency after introduction of HIV self-testing and network distribution among South African MSM. J Acquir Immune Defic Syndr. 2018;77(3):279–87.

    Article  Google Scholar 

  31. Okoboi S, Twimukye A, Lazarus O, et al. Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda: a qualitative study. J Int AIDS Soc. 2019;22(3):e25269.

    Article  Google Scholar 

  32. Zerbe A, DiCarlo AL, Mantell JE, Remien RH, Morris DD, Frederix K, Pitt B, Peters ZJ, El-Sadr WM. Acceptability and uptake of home-based HIV self-testing in Lesotho. In: 19th conference on retroviruses and opportunistic infections, Seattle, WA. 2015.

  33. Hlongwa M, Mashamba-Thompson T, Makhunga S, Hlongwana K. Mapping evidence of intervention strategies to improving men’s uptake to HIV testing services in sub-Saharan Africa: a systematic scoping review. BMC Infect Dis. 2019;19(1):496.

    Article  Google Scholar 

  34. Wanyama JN, Nabaggala SM, Kiragga A, et al. High mobile phone ownership but low internet access and use among young adults attending an urban HIV clinic in Uganda. Vulnerable Children Youth Stud. 2018;13(3):207–20.

    Article  Google Scholar 

  35. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528(7580):S77-85.

    Article  Google Scholar 

  36. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26.

    Article  Google Scholar 

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Acknowledgements

We thank the participants for their time and effort during the study.

Funding

Funding for this project is provided by the University of Minnesota Academic Health Center's Global Health Seed Grant program to support international research.

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Authors and Affiliations

  1. Department of Psychology, San Diego State University, San Diego, CA, USA

    Keith J. Horvath

  2. The Medical Concierge Group Limited, Kampala, Uganda

    John Mark Bwanika, Joy Banonya, Joan Atuhaire, Louis H. Kamulegeya & Davis Musinguzi

  3. Infectious Diseases Institute Limited, Kampala, Uganda

    John Mark Bwanika, Grace Banturaki & Agnes N. Kiragga

  4. School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Keith J. Horvath & Sara Lammert

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  1. Keith J. Horvath
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Correspondence to Keith J. Horvath.

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Horvath, K.J., Bwanika, J.M., Lammert, S. et al. HiSTEP: A Single-Arm Pilot Study of a Technology-Assisted HIV Self-testing Intervention in Kampala, Uganda. AIDS Behav 26, 935–946 (2022). https://doi.org/10.1007/s10461-021-03449-9

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