Designing an Intervention to Increase Men's Linkage to Care and Prevention after HIV Self-Testing in Uganda

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PROJECT SUMMARY/ABSTRACT The success of HIV treatment and prevention in sub-Saharan Africa (SSA) is hindered by the gender disparity in access to care. Men in SSA are less likely to undergo HIV testing and more likely to start antiretroviral treatment (ART) at advanced disease stages compared to women, resulting in poorer clinical outcomes. HIV self-testing (HIVST) is shown to be an innovating and empowering method to increase HIV testing coverage in men. In particular, secondary distribution of HIV self-tests to men from their female partners has achieved high uptake in men. However, men’s linkage to care after HIVST is not well evaluated. As clinic linkage is a crucial step to accessing lifesaving ART and prevention including pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC), the success of HIVST interventions in reducing HIV burden hinges on their ability to link individuals to care. The goal of this K01 Award is to broaden the candidate’s expertise to conduct independent research in global HIV prevention, with a focus on optimizing HIVST and linkage strategies. To complete this research, the candidate will develop new competencies in 1) qualitative research and behavioral science, 2) behavioral economics, and 3) implementation science. These skills build nicely on the candidate’s current proficiencies in epidemiology, mathematical modeling, and cost-effectiveness analyses. This newly developed skillset will enable the candidate to design, evaluate, and adapt locally relevant and scalable HIV interventions to reduce HIV burden in SSA. The candidate has assembled a robust, multidisciplinary mentorship team to guide her research and career development. The research will be conducted in Kampala, Uganda, within a Prevention of Mother to Child Transmission (PMTCT) clinic. This is an ideal setting in which to evaluate the effectiveness of secondary distribution of HIV self-tests. Pregnant women commonly report not knowing the HIV-status of their male partner. Furthermore, testing partners of HIV-positive women is a high yield strategy to identify HIV-positive men in need of ART as well as HIV-negative men serodiscordant partnerships who can benefit from PrEP and VMMC. Interviews will be conducted with men regarding their barriers and motivators for linkage and with providers/stakeholders regarding the feasibility of integrating the potential interventions into clinic practice (Aim 1). Using the intervention characteristics identified in Aim 1, the candidate will create and administer a Discrete Choice Experiment (DCE) to men with HIV-positive female partners (Aim 2). The DCE elicit characteristics of men’s preferred HIVST intervention, which will be used to develop a tailored intervention for optimal uptake. Finally, the candidate will pilot-test the optimal HIV-self testing intervention to 50 pregnant women starting PMTCT and their male partners. She will evaluate the intervention’s acceptability and effectiveness in linking men to confirmatory HIV testing, treatment and prevention (Aim 3). This research is the first to evaluate an intervention to motivate male linkage to care after HIV self-testing. It has the potential to identify strategies to increase HIV testing and linkage to care in SSA.