Ukubandakanya abesilisisa: HIV self-testing for Partners of HIV-uninfected Postpartum Women to facilitate PrEP and ART uptake to promote HIV treatment and prevention

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PROJECT SUMMARY Perinatal women in South Africa (SA) have one of the highest HIV infection rates in the world, and are almost exclusively infected via sexual contact from male partners. The postpartum period is an increased time of risk for HIV. If women become HIV infected at the end of pregnancy or during the postpartum period, HIV may be transmitted to the infant via breastfeeding. Women and men in partnerships in SA do not always know each other’s HIV statuses. This can make HIV prevention difficult, particularly in SA, where men are less likely to be tested for HIV than women. HIV-uninfected women have the option of using pre-exposure prophylaxis (PrEP) to help them remain HIV-uninfected; men with HIV (MWH) who know their status, and who take treatment effectively, are unlikely to transmit HIV to their female partners. Men are now able to test themselves for HIV using HIV self-test (HIVST) kits; use of these kits has the potential to circumvent barriers to traditional, clinic- based HIV testing, such as concerns about stigma or privacy, or competing demands, like busy work schedules. Our earlier work suggests that men are willing to engage in behaviors to protect their female partners from HIV during attempts to conceive in order to protect their offspring, including HIV testing. Providing HIV-uninfected women with HIVST kits for male partner distribution and HIV prevention counseling during the early postpartum period may help women remain HIV-uninfected during this time of increased risk, and may also identify MWH and help those men engage in HIV care. Thus, this study has the following objectives: (1) to refine the content of a combination intervention to promote HIVST for Partners and PrEP uptake for HIV-uninfected Postpartum Women (“H4P”) via focus group discussion feedback from women and men in SA who have had a child in the past year (N = up to 10 women and 10 men); (2) to conduct a randomized pilot trial of the H4P intervention for postpartum HIV-uninfected women (N = 60 and their male partners) in KwaZulu-Natal, SA, who report a partner of unknown serostatus. All women will receive HIVST kits and standardized health information for distribution to male partners; those randomized to the H4P intervention arm will also receive PrEP uptake counseling, and male partners will receive reproductive health-centered information about why HIV testing is important. Feasibility and acceptability will be assessed. (3a) To evaluate preliminary effectiveness by calculating, across intervention/control arms at three months post-intervention, the proportion of women initiating PrEP among those whose partners test positive, do not test, or do not share a test result, and the proportion of men with a positive test who link to HIV care. (3b) To conduct individual qualitative interviews with a subset of enrolled women and their partners (N = up to 10-15 women and men) in the intervention arm to explore opportunities to optimize the intervention.