Strengthening global HIV self-testing guidelines
Context
Testing is vital in the fight to treat and prevent HIV. In Kenya, 80 per cent of adults are covered under the HIV testing and counselling (HTC) service, but uptake of HTC amongst men lags significantly behind women. The same gender gap exists in other countries in Sub-Saharan Africa. Evidence shows that efforts to encourage women to refer their male partners for HTC have had limited success. Therefore, studies have recommended increasing the uptake of HIVST to prevent new HIV infections and effectively treat known cases of HIV.
In 2013, the concept of distributing HIVST kits to female individuals in stable partnerships was mentioned as a promising approach to initiating couples testing. But, there was no robust study that confirmed the idea's acceptability or effectiveness and no delivery mechanisms had been established for providing HIVST kits. Researchers from the University of North Carolina and Impact Research and Development Organisation, Kenya, collaborated in 2014 to fill this knowledge gap, with support from 3ie.
The 3ie-supported researchers examined whether providing HIVST kits could improve HIV testing uptake amongst male partners of women attending antenatal care centres. The study was conducted in Kisumu County in the Nyanza region of western Kenya. Six hundred female participants were randomly enrolled in intervention and comparison groups. The participants in the intervention group received two oral, fluid-based HIV test kits, along with instructions on how to use them. Participants in the comparison group received an invitation card to give to their partners for clinic-based HIV testing.
Apart from Kenya, simultaneous pilot studies were testing the effectiveness of HIVST in different contexts and with different target population, in Uganda and Zambia, in collaboration with 3ie. The Ugandan Ministry of Health was also in the process of revising its HIV Testing Services Policy and Implementation Guidelines and keen to learn from the evidence generated on HIVST by 3ie studies in these countries.
Evidence
The findings showed a higher uptake rate of HIV testing in the intervention group, which received the self-tests, than the comparison group, which did not, with 90.8 per cent of partners testing in the intervention group. The study also demonstrated the social acceptability of HIVST.
The study results also showed the effectiveness of HIVST in general, as the intervention overcame many of the barriers that prevent HIV testing from reaching high-risk men, such as stigma. Additionally, the study helped female participants learn the HIV status of their partners.
Evidence impacts
Type of impact: Inform the design of other programmes
Where findings from the evaluation or review inform the design of a programme(s) other than the one(s) evaluated.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowAfter learning about the 3ie evidence programme on HIVST, the Ugandan government expressed its interest in learning from the studies and modifying their own HIV testing service guidelines. The positive and policy relevant results from this evaluation, and its timely release, led the Ugandan Ministry of Health to include antenatal care centres as a delivery mechanism for HIVST in the 2018 addendum issued to Uganda’s National HIV Testing Services Policy and Implementation Guidelines.
Type of impact: Inform global guidelines and policy discussions
When findings from an evaluation or review can be traced to discussions or actions. Examples include governments or multilateral or bilateral donors’ mentioning the findings to inform policy or programming. To date, we have only one case of an individual impact evaluation informing global health guidelines. WHO guidelines require that the guidance is based on randomised evaluation evidence.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowWHO cites 3ie evaluation findings in strongly recommending that HIVST be offered and in supporting implementation and scale-up of ethical, acceptable and evidence-based approaches to HIVST. WHO also refers to ANC centres as an effective delivery mechanism for reaching men who would not otherwise be tested. The recommendation appears in the organisation's Consolidated guidelines on HIV testing services released in December 2019, citing evidence from various sources, including the research conducted by 3ie. These update the previous supplementary guidance to the Consolidated Guidelines on HIV Testing Services released in December 2016. The supplementary guidelines supported implementation and scale-up of ethical, acceptable and evidence-informed approaches to HIVST. The 2016 and 2019 guidelines cited findings from several examples, including the 3ie-supported evaluation in Kenya, relevant to efforts aimed at reaching men who were using HIVST services at lower rates.
Suggested citation
International Initiative for Impact Evaluation (3ie), 2020. Strengthening global HIV self-testing guidelines [online summary], Evidence Impact Summaries. New Delhi:3ie.
Related
Blog: Preparation meets opportunity: how 3ie’s stakeholder engagement paid off on HIV self-testing
This blog describes how 3ie’s HIV Self Testing evidence programme emphasised stakeholder engagement and provided relevant evidence to decision makers.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to influence@3ieimpact.org
Last updated on 5th November 2020