To meet the UNAIDS 90/90/90 goal it is imperative to increase HIV testing uptake. HIV Self-Testing (HIVST) may increase early HIV detection, particularly among young people. Secondary distribution of test kits to peers/partners may be a good way to reach young people who do not attend traditional health services.
From December 2016 – July 2017 we enrolled 284 South African young women age 18-24 years in a randomized control trial to examine HIV testing uptake among those randomized to either: 1) an invitation to a local clinic for free HIV Counseling and Testing (HCT) or, 2) choice of free HCT or HIV Self-testing (HIVST) kits. Young women choosing HIVST in the choice arm were provided with 5 HIVST kits (OraQuick); young women randomized to or choosing HCT were given 5 invitations to test for free at local clinics. Four kits/invitations were intended for distribution to peers and partners plus one for themselves. Young women were invited to return 3 months after enrollment to assess testing uptake between the two arms and distribution to peers and partners. We examined differences in testing between arms using Wald crude risk differences and crude risk ratios.
We randomized 144 young women to the HCT arm and 140 to the HIVST/choice arm. Of those randomized to choice, 134 (96%) chose HIVST and 6 chose HCT. By September 21, 2017, 247 women had returned for their 3-month visit (121 in the HIVST/choice arm, 126 in the HCT arm). At the 3-month visit, 97% of women in the HIVST/choice arm reported testing compared to 48% of women in the HCT arm, a risk difference of 48% (Relative Risk 2.00 95% CI 1.66-2.40). These women reported inviting 465 peers (80% female) and 35 partners to test– 170 (34%) by HCT arm participants and 330 (66%) by choice arm participants.
We found that providing young women with a choice to self-test in addition to the option of clinic-based HCT led to 97% testing uptake within three months-virtually all through self-testing. In comparison, those offered HCT alone reported only half that amount of testing. In addition, we saw substantially more peer-referrals among women offered HIVST compared to the HCT arm. Many countries in sub-Saharan Africa are considering offering HIVST as another HIV testing option; we present strong evidence that this strategy will result in a substantial increase in HIV testing among young people compared with current practice.