Title

Retesting for HIV among individuals on ART during community-based distribution of HIV self-tests – a mixed-methods study in rural Zimbabwe

Presenter

Euphemia Lindelwe Sibanda

Authors

E.L. Sibanda^1,2, C. Madanhire¹, M. Neuman³, N. Ruhode¹, M. Mutseta⁴, J. Dirawo¹, C. Johnson⁵, K. Hatzold⁶, K. Fielding³, E.L. Corbett³, F.M. Cowan^2,1, M. Taegtmeyer³

Institutions

¹CeSHHAR Zimbabwe, Harare, Zimbabwe, ²Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, United Kingdom, ³London School of Hygiene & Tropical Medicine, London, United States, ⁴Population Solutions for Health, Harare, Zimbabwe, ⁵World Health Organisation, Geneva, Switzerland, ⁶Population Services International, Cape Town, South Africa

BACKGROUND: As testing and treatment scale-up in Africa, retesting among people living with HIV (PLHIV) who know their status is increasing. We nested an investigation of retesting among PLHIV on ART in a trial comparing community-led with programme-led distribution of HIV self-tests (HIVST).
METHODS: In community-led and programme-led arms, for four weeks HIVST distribution was done by communities or paid distributors respectively. Four months post-distribution, we conducted a survey to evaluate individual-level testing/treatment/prevention outcomes. We determined prevalence of self-testing while on ART and used logistic regression to determine predictors, adjusting for confounders and clustering (random effects). Additionally, we conducted in-depth interviews with distributors (n=13) and PLHIV on ART who retested (n=11). Interviews were analysed using Framework Analysis.
RESULTS: Among 11,150 surveyed participants, 1,292 were on ART during HIVST distribution, including 671 (51.9%) in the community-led arm. Retesting on ART was common (327/1,292, 25.3%). Young men were more likely than young women to retest on ART, adjusted OR 5.3 (95% CI 1.65-17.08) and 2.28 (1.26-5.28) for 16-19 and 20-29 age groups respectively (Table), p-value for interaction=0.04.

Qualitative interviews suggested that re-testers understood the potential for false negative results. They re-tested because of: i) belief that HIVST had role in determining if treatment was working: “…a negative or faint positive result means your body’s soldiers (immune system) are good”; ii) confirming previous HIV diagnosis, iii) opportunity to disclose HIV status to partner/family/friend; iv) social responsibility to support an important community-based program, with fear of future exclusions if declined, v) fear that HIVST refusal could be interpreted as disclosure of HIV status. Easy HIVST availability facilitated re-testing.
CONCLUSIONS: Community-based distribution of HIVST is associated with high levels of retesting among people on ART. Understanding drivers of retesting can enable programmes to develop more appropriate communications and interventions that meet the needs of people on ART.