PHD-Department of Community Health

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Browsing PHD-Department of Community Health by Author "Machera, Tom Marwa"

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    The Effects of Using Oral HIV Self-Testing Kits on Uptake of Male Partner Testing Among Pregnant Women in Selected Counties In Kenya
    (Kenyatta University, 2018) Machera, Tom Marwa
    Adult HIV prevalence peaked at 14% in Kenya in the mid-nineties and has since continued to drop and thereafter stabilized at below 5% since 2014 due mainly to a scale up of various evidence based HIV interventions including HIV care and treatment, PMTCT, VMMC, HTS among other. HIV-testing and counselling (HTC) is a very effective strategy in getting those infected with HIV into care and treatment and in making appropriate referrals to other HIV support services. Kenya has adopted a number of strategies including Provider initiated testing and counselling (PITC), outreach testing and counselling and home based testing and counselling. Women are more likely to be tested for HIV (79.8%) than their male counterparts (62.5%) are. Other strategies that have proved effective are integration of HTC in antenatal care and reproductive health services. The Kenya AIDS Indicator Survey (KAIS) of 2012 showed that up to 6.5% of pregnant women in Kenya were living with HIV, and that each year, close to about 45,000 infants becomes infected with HIV through mother-to-child transmission of HIV (MTCT). PMTCT is offered as part of routine ANC for pregnant women, alongside other important services such as HTC, linkages to care and treatment, and helps to prevent infant exposure to HIV during pregnancy, delivery and breastfeeding. However, many approaches to promote male involvement in HIV counselling and testing during ANC services, such as having male-only clinics on special days or evening clinics have been tried without much success. ANC in Kenya have the potential of being key entry points to HTC not only for pregnant women, but also their partners. This study was designed as randomized controlled trial (RCT) with three study arms, where 475 study participants were to be rolled randomly into each arm. The study participants were women attending ANC clinic for the first time in their current pregnancy. Fourteen (14) study sites were selected randomly from 180HIV testing, care and treatment sites in Eastern and Central regions of Kenya. The aim of the study was to determine if provision of oral HIV home testing kits would increase male partner testing rates, self-testing acceptability rates and identify operational challenges experienced by the ANC mothers when providing test kits to their male partners. Data was collected using pre-tested questionnaire which were administered to each of the 1217 women and 1133 men randomized into the three study arms. Four focus group discussions were conducted for females whose partners tested and those who never tested. Data analysis was done using SPSS and “R” statistical software and descriptive statistics used to examine the frequency and analysis of variance. The equivalence t-test showed a statistically significant differences (p-value=0.01, n=737, df= 2) between arm one and two while arm three was superior to arm 2 with significantly higher testing rates (P-value<0.001,n=758,df=2).Men who got the two intervention (special letter and a test kit)were 5.08 times more likely to test compared to men who got the special letter alone when controlling for age, employment, education and if the couples discussed HIV testing)The study presented a new understanding and dynamics of self-testing among men while also bringing about health impact for their pregnant partners, because it did not require men to go to ANC clinics in person. In arm three (those who got two interventions), over 80%of the men took HIV test compared to only 37.0 %in arm two (those who got one intervention; a card with HIV prevention messages alone) and 28.3%in arm one (standard package, a letter given to the ANC mother inviting her male spouse to come to the clinic, this is the current practice in Kenya). Men who discussed HIV testing with their wives were twelve times more likely to test for HIV compared to men who did not discuss HIV testing with their wives. This findings will inform HIV programs and policy makers on the best way to improve low testing rates among partners of ANC clients and also demonstrates how self-testing may provide males who are not currently reached by HTS an opportunity to test in private.