Offering self-administered oral HIV testing to truck drivers in Kenya to increase testing: a randomized controlled trial

ABSTRACT

We conducted a randomized controlled trial among 305 truck drivers from two North Star Alliance roadside wellness clinics in Kenya to see if offering HIV testing choices would increase HIV testing uptake. Participants were randomized to be offered (1) a provider-administered rapid blood (finger-prick) HIV test (i.e., standard of care [SOC]) or (2) a Choice between SOC or a self-administered oral rapid HIV test with provider supervision in the clinic. Participants in the Choice arm who refused HIV testing in the clinic were offered a test kit for home use with phone-based posttest counseling. We compared HIV test uptake using the Mantel Haenszel odds ratio (OR) adjusting for clinic.

Those in the Choice arm had higher odds of HIV test uptake than those in the SOC arm (OR = 1.5), but the difference was not statistically significant (p = 0.189). When adding the option to take an HIV test kit for home use, the Choice arm had significantly greater odds of testing uptake (OR = 2.8, p = 0.002). Of those in the Choice arm who tested, 26.9% selected the SOC test, 64.6% chose supervised self-testing in the clinic, and 8.5% took a test kit for home use.

Participants varied in the HIV test they selected when given choices. Importantly, when participants who refused HIV testing in the clinic were offered a test kit for home use, an additional 8.5% tested. Offering truck drivers a variety of HIV testing choices may increase HIV testing uptake in this key population.

KEYWORDS:

• Diagnostic tests
• HIV
• HIV testing
• Kenya

Acknowledgements

This trial is registered with the Registry for International Development Impact Evaluations (RIDE ID# 55847d64a454f). Elizabeth Kelvin was responsible for the study design, management, data analysis and writing of this manuscript. Gavin George and Joanne Mantell collaborated on the study design and management and editing of the manuscript. Eston Nyaga and Eva Mwai collaborated on the design of the study, were responsible for oversight of the study implementation and reviewed the manuscript. Jacob Odhiambo was responsible for monitoring the study implementation, helping with the study management, data cleaning, and editing the manuscript. Matthew Romo and Lila Starbuck were responsible for data cleaning, variable definition, and editing the manuscript. Kaymarlin Govender collaborated on the study design and edited the manuscript. We also want to thank the Fieldworkers, Alice Opiyo, Deborah Ochungo, Lucy Wanjiru, and Oliver Simiyu, who recruited the study participants and conducted the interviews, the NSA staff at the two study clinics, who helped with clinic flow during the study, and at the Nairobi office, who helped with administrative requirements such as ethics committee applications, as well as the study participants.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by a grant from the International Initiative for Impact Evaluation (3IE) TW2.2.06, Principal Investigator: Elizabeth A. Kelvin, Ph.D.]. Support for Co-Investigator, Joanne Mantell, also came from a center grant from the National Institute of Mental Health (NIMH) to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University [P30-MH43520; Principal Investigator: Robert H. Remien, Ph.D.].