1. Among adults who underwent HIV self-testing in Malawi, offering home initiation of care increased anti-retroviral therapy initiation compared to standard HIV care.
2. Combined across both study groups, 72.5% of ART initiators were still taking ART six months after diagnosis.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Testing for HIV and providing access to care for individuals who do test positive remain challenging in sub-Saharan Africa. While HIV self-testing allows for privacy and convenience, there is a risk of a delay to HIV treatment initiation. This is one of the first studies to assess the association between HIV self-testing and the initiation of HIV care.
These study findings suggest an effective method for controlling the HIV epidemic—anti-retroviral therapy (ART) initiation at home increases when HIV self-testing occurs at home. Strengths of this study include the use of randomized clusters within a city with a high prevalence of HIV and high number of participants. Limitations of the study include the fact that reporting results was optional to maintain privacy and confidentiality; as a result, individual HIV self-testing participants were not followed up as a cohort. Additionally, there were few ART initiators; these individuals were followed up for only six months and clinical outcomes were not assessed. Thus, a larger and longer study may be warranted to provide conclusive evidence.
Click to read the study in JAMA
In-Depth [cluster randomized trial]: This study was conducted in Blantyre, Malawi. Fourteen clusters underwent randomization into one of two groups: 1) HIV self-testing, then optional home initiation of care, or 2) HIV self-testing followed by facility-based care. The primary outcome was the proportion of adults who initiated ART within six months of HIV self-testing. During the study period, 58% of adults underwent HIV self-testing, and participants in the home group were more likely to report positive test results compared to those in the facility group (6.0% vs. 3.3%, Risk Ratio [RR] 1.23, 95% CI, 1.16-2.97, p= 0.006). A significantly greater proportion of adults in the home group initiated ART compared to the facility group, at 2.2% vs. 0.7%, respectively (RR 2.94, 95% CI 2.10-4.12, p<0.001). With consideration of other factors and an absolute difference of 1.5% between the two groups, an additional 7.9 per 100 HIV-infected adult residents initiated ART when both HIV self-testing and home initiation of HIV care were offered.
More from this author: Stroke within past 9 months linked with adverse surgical outcomes
©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT.
