2023-09-28 14:46:10 +00:00
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abstract: 'Background HIV self-testing can overcome barriers to HIV testing, but
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its potential as an HIV prevention strategy for women in sub-Saharan
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Africa has not been assessed. We examined whether sustained provision of
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self-tests to women promotes testing among sexual partners and reduces
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HIV incidence.
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Methods We conducted a pair-matched cluster-randomised trial in 66
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community clusters in Siaya County, Kenya. Clusters were communities
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with a high prevalence of transactional sex, including beach communities
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along Lake Victoria and inland communities with hotspots for
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transactional sex such as bars and hotels. Within clusters, we recruited
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HIV-negative women aged 18 years or older with two or more sexual
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partners within the past 4 weeks. In each of the 33 cluster pairs, we
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randomly assigned clusters to an intervention and comparison group. In
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intervention clusters, we provided participants with multiple self-tests
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at regular intervals and encouraged secondary distribution of self-tests
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to sexual partners. In comparison clusters, we provided participants
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referral cards for facility-based testing. Follow-up visits and HIV
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testing occurred at 6-month intervals for up to 24 months. The primary
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outcome of HIV incidence among all participants who contributed at least
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one HIV test was analysed using discrete-time mixed effects models. This
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study is registered with ClinicalTrials.gov, NCT03135067.
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Findings Between June 4, 2017, and Aug 31, 2018, we enrolled 2090
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participants (1033 in the 33 intervention clusters and 1057 in the 33
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comparison clusters). Participants'' median age was 25 years (IQR 22-31)
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and 1390 (66.6\%) of 2086 participants reported sex work as an income
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source. 1840 participants completed the 18-month follow-up and 570
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participants completed the 24-month follow up, which ended on March 25,
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2020, with a median follow-up duration of 17.6 months. HIV incidence was
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not significantly different between the intervention and comparison
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groups (1.2 vs 1.0 per 100 person-years; hazard ratio 12, 95\% CI
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0.6-2.3, p=0.64). Social harms related to study participation occurred
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in three participants (two in the intervention group and one in the
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comparison group).
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Interpretation Sustained provision of multiple self-tests to women at
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high risk of HIV infection in Kenya enabled secondary distribution of
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self-tests to sexual partners but did not affect HIV incidence.
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Copyright (C) 2021 Published by Elsevier Ltd. All rights reserved.'
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affiliation: 'Thirumurthy, H (Corresponding Author), Univ Penn, Dept Med Eth \& Hlth
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Policy, Philadelphia, PA 19004 USA.
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Thirumurthy, Harsha; Bair, Elizabeth F.; Marcus, Noora, Univ Penn, Perelman Sch
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Med, Dept Med Eth \& Hlth Policy, Philadelphia, PA 19004 USA.
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Putt, Mary, Univ Penn, Perelman Sch Med, Dept Biostat \& Epidemiol, Philadelphia,
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PA 19004 USA.
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Ochwal, Perez; Agot, Kawango, Impact Res \& Dev Org, Kisumu, Kenya.
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Maman, Suzanne, Univ N Carolina, Dept Hlth Behav, Chapel Hill, NC 27515 USA.
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Napierala, Sue, RTI Int, Womens Global Hlth Imperat, Berkeley, CA USA.'
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author: Thirumurthy, Harsha and Bair, Elizabeth F. and Ochwal, Perez and Marcus, Noora
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and Putt, Mary and Maman, Suzanne and Napierala, Sue and Agot, Kawango
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author-email: hthirumu@upenn.edu
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author_list:
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- family: Thirumurthy
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given: Harsha
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- family: Bair
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given: Elizabeth F.
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- family: Ochwal
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given: Perez
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- family: Marcus
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given: Noora
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- family: Putt
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given: Mary
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- family: Maman
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given: Suzanne
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- family: Napierala
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given: Sue
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- family: Agot
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given: Kawango
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da: '2023-09-28'
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files: []
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issn: 2352-3018
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journal: LANCET HIV
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keywords-plus: 'FEMALE SEX WORKERS; NYANZA PROVINCE; TRANSMISSION; MIGRANTS; CLIENTS;
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RISKS; CARE'
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language: English
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month: DEC
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number: '12'
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number-of-cited-references: '27'
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orcid-numbers: Napierala, Sue/0000-0003-1146-8154
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pages: E736-E746
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papis_id: 3efc37b871b17991064334e62b6a8fb1
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ref: Thirumurthy2021effectproviding
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times-cited: '4'
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title: 'The effect of providing women sustained access to HIV self-tests on male partner
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testing, couples testing, and HIV incidence in Kenya: a cluster-randomised trial'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000725254500006
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usage-count-last-180-days: '1'
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usage-count-since-2013: '3'
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volume: '8'
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web-of-science-categories: Immunology; Infectious Diseases
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year: '2021'
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