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SELF-TESTS FOR AT-HOME PARTNER TESTING ARE ACCEPTABLE & UTILIZED AMONG PREGNANT WOMEN
Jillian Pintye1, John Kinuthia2, Felix Abuna3, Nancy M. Ngumbau2, Salphine A. Wattoyi2, Mary M. Marwa2, Anjuli D. Wagner1, Julia C. Dettinger1, Laurén Gómez1, Ben O. Odhiambo2, Jared Baeten1, Grace John-Stewart1
1University of Washington, Seattle, WA, USA,2Kenyatta National Hospital, Nairobi, Kenya,3University of Washington in Kenya, Nairobi, Kenya
Increasing male partner and couples HIV testing among pregnant women in HIV high-burden settings remains a challenge. Secondary distribution of HIV self-tests within routine antenatal care (ANC) could provide an opportunity to close the gap on partner and couples testing.
In an ongoing cluster RCT (NCT03070600), we offered self-tests for at-home partner HIV self-testing (HIVST) to HIV-uninfected adult women seeking routine ANC services at 10 facilities in Siaya and Homa Bay, Kenya as part of the PrEP Implementation for Mothers in ANC (PrIMA) Study. Women were provided with instructions on how to use self-tests and received at least 2 oral-fluid-based rapid HIV tests (OraQuick Rapid HIV-1/2 Antibody Test, OraSure Technologies). Data on HIVST outcomes were ascertained in-person at one-month follow-up visits.
Overall, 1239 pregnant HIV-uninfected women with male partners were offered self-tests for at-home partner HIVST. Median age was 23 years (IQR 20-28) and median gestational age was 24 weeks (IQR 20-28). Most women (75%) were in monogamous marriages; 11% were in polygamous marriages; 14% were unmarried. Overall, 43% reported having a partner of unknown HIV status; 52% had an HIV-uninfected partner and 5% HIV-infected. Among all women, 68% accepted self-tests. Self-test acceptance was 73%, 69%, and 20% among women whose partners' HIV status was unknown, HIV-uninfected, and HIV-infected, respectively. Among women with partners of unknown HIV status, the most frequently (48%) reported reason for declining self-tests was needing to consult their partner; 10% reported fear of intimate partner violence (IPV). HIVST outcomes were available for 391 (73%) women with partners of unknown HIV status. Among these women, 56% offered self-tests to their male partner; 20% had not seen their male partner since accepting self-tests and 13% feared their partner's reaction and/or IPV. Among women who offered self-tests to their partner, 92% reported their partner used the self-test and 96% used a self-test with their partner; 6 (2%) male partners with previously unknown HIV status tested positive using self-tests.
Within routine ANC, acceptance of at-home male partner HIVST was high and frequently led to couples' HIV, enhancing mutual knowledge of HIV status. IPV was a barrier to acceptance and offering of self-tests. Given low male attendance at clinics, distributed HIVST is an attractive strategy to improve male partner HIV testing.