Submission ID 131971
| Issue/Objective | HIV testing is the entry point to HIV prevention and care, yet adolescent girls and young women (AGYW) in rural sub-Saharan Africa continue to face persistent barriers accessing these services. Peer-led HIV self-testing (HIVST) with community health worker (CHW) facilitation may extend confidential testing, but implementation evidence in rural post-conflict settings remains limited. |
|---|---|
| Methodology/Approach | We conducted a quasi-experimental implementation science study using repeated pre- and post-intervention surveys and routine implementation monitoring data. Surveys were conducted from July to September 2024 and July to September 2025, before and after an April-June 2025 intervention. AGYW aged 15-24 years were selected from five rural sub-counties using systematic random sampling, with 415 participants per survey wave. The intervention trained 10 CHWs and 30 AGYW peer leaders to distribute 700 HIVST kits, provide instructions and follow-up support, and facilitate referral for confirmatory testing and care. Implementation outcomes were summarized descriptively. Pre-post changes were summarized as percentage-point (pp) differences, and adjusted associations were estimated using modified Poisson regression with robust standard errors. |
| Results | Of 700 HIVST kits allocated to CHWs, 691 (98.7%) were transferred to peer leaders, who distributed 672 kits, including 613 to AGYW and 59 to spouses or partners. In the post-intervention survey, 192 of 415 AGYW (46.3%) received an HIVST kit, and 188 of 192 recipients (97.9%) self-tested. Acceptability was high (89.4% to 94.2% across items), most appropriateness items were highly endorsed (88.9%-92.3%), and feasibility items ranged from 71.6% to 87.0%, but perceived kit accuracy was lower (55.2%). HIVST awareness increased from 28.2% to 72.5% (+45.3 pp), HIVST uptake from 6.2% to 44.1% (+37.9 pp), and ever testing for HIV from 76.9% to 91.3% (+15.9 pp). Adjusted models showed higher post-intervention HIVST awareness (adjusted prevalence ratio [aPR] 2.57, 95% CI 2.17-3.04), HIVST uptake (aPR 7.12, 95% CI 4.82-10.52), and ever testing for HIV (aPR 1.16, 95% CI 1.11-1.23). |
| Discussion/Conclusion | A peer-led, CHW-facilitated HIVST intervention was feasible, acceptable, appropriate, and associated with increased HIVST awareness, HIVST uptake, and HIV testing among AGYW. A controlled hybrid effectiveness-implementation trial is warranted to estimate causal effectiveness, assess sustainability and costs, and refine linkage strategies. |
| Presenters and Affiliations | Ronald Olum Makerere University School of Public Health Morrish Okello Makerere University School of Public Health Freddy Kitutu Makerere University Elvin Geng Washington University in St. Louis Philippa Musoke MUJHU Research Collaboration |
