Linkage to HIV care following HIV selftesting results

Linkage to HIV care following HIV self-testing: results from a cluster-randomized trial nested in four HPTN 071 communities in Zambia Sian Floyd, Kwame Shanaube, Ab Schaap, Mwelwa Phiri, Bernadette Hensen, Chama Mulubwa, Virginia Bond, Bwalya Chiti, Musonda Simwinga, Richard Hayes, Sarah Fidler, Alwyn Mwinga, Helen Ayles IAS CONFERENCE, JULY 26 2018 U. S. NATIONAL INSTITUTES OF HEALTH: National Institute of Allergy and Infectious Diseases National Institute of Mental Health National Institute on Drug Abuse

Background and study design • • For individuals who self-test and the result is HIV-positive: limited evidence about how to ensure (1) linkage to confirmatory testing & (2) linkage to HIV care (LTC) HIV self-testing (HIVST) cluster-randomized trial, nested in four of the HPTN 071 (Pop. ART) study communities in Zambia Pop. ART intervention: delivered 2014 -2017, in “annual rounds”, during which community HIV care providers (CHi. Ps) visited all households and offered homebased HIV testing with a rapid diagnostic test using fingerprick blood (RDT), referral of HIV-positive individuals to HIV care, and support for LTC. Each community divided into CHi. P zones; one CHi. P team – a pair of CHi. Ps – for each zone. ~500 households per zone. HIVST intervention: HIVST offered as an alternative to testing with an RDT on a fingerprick blood sample. HIVST offered in person, supervised or unsupervised, and to absent partners via secondary distribution. 33 CHi. P zones randomized to receive HIVST intervention, 33 to continue to receive standard Pop. ART intervention. Delivered February – September 2017. CHi. P follow-up visits to support LTC up to September 30 2017.

Time from CHi. P referral to linkage to HIV care (LTC) By HIVST trial arm Estimated percentage LTC by 3 months after referral, among individuals diagnosed HIV-positive: 64% in non-HIVST zones, 65% in HIVST zones • In non-HIVST arm: 204 individuals were diagnosed HIV-positive on an RDT • In HIVST arm: for 237 individuals, the first HIV test result was HIVpositive Among the 237, for the first HIV test: (i) 21 self-tested via secondary distribution; 13 did not have confirmatory RDT; (ii) 109 self-tested with CHi. P supervision; 19 did not have confirmatory RDT; (iii) 18 self-tested after meeting the CHi. P in person, but tested unsupervised; 1 did not have confirmatory RDT; (iv) 89 first tested with an RDT. 195 individuals were diagnosed HIVpositive on initial, or confirmatory, RDT

Time from CHi. P referral to LTC, 33 HIVST zones By testing option chosen for first HIV test • Suggestion that LTC was slower for individuals who first tested with unsupervised self-testing (n=14), or via secondary distribution (n=5) • Compared with those who first tested with RDT (n=85) or supervised self-testing (n=80) • • Conclusions: LTC following an HIV-positive diagnosis and referral to HIV care was not undermined by offering HIVST as a testing option, in the context of LTC support Strategies are needed to facilitate confirmatory RDT following an HIV-positive self-test result, and LTC following unsupervised self-testing and secondary distribution