The Effects of Using Oral HIV Self-Testing Kits on Uptake of Male Partner Testing Among Pregnant Women in Selected Counties In Kenya
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Date
2018
Authors
Machera, Tom Marwa
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
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.
Description
A Research Thesis Submitted in Partial Fullfilment of the Requirements for the Award of the Degree of Doctor of Phylosophy in Epidemiology in the School of Public Health of Kenyatta University. November, 2018