Formative work to develop an intervention to support dual HIV/syphilis self-testing and linkage to PrEP and/or HIV/syphilis treatment for women in South Africa: The THANDO Study

University Of Colorado Denver, Aurora CO

Investigators

Abstract

In South Africa, the country with the world’s largest HIV epidemic, an estimated 15-25% of women are living with HIV. Of these, estimates show that 35.5% are not in treatment. Furthermore, there is low engagement with HIV prevention behaviors, such as ever having an HIV test (~20% of women have never tested for HIV) and pre-exposure prophylaxis (PrEP) use (women’s openness to using PrEP is ~65-80%, only). Data on syphilis outcomes, which significantly increase risk for HIV and viral load if already living with HIV, are unknown in this context; though one estimate of prevalence is ~9%. Dual self-testing for HIV and syphilis may be a promising strategy to improve uptake of regular HIV/syphilis testing and linkage to PrEP and/or HIV/syphilis treatment among women in this context. Specifically, self-testing is overwhelmingly supported by stakeholders in South Africa, the infrastructure to scale-up self-testing is in place and rapidly expanding, analyses show that this strategy is life and cost-saving, and PrEP and HIV/syphilis treatment are widely available. Also, self-testing may address the unique social/structural barriers affecting regular testing and subsequent linkage to services, including health system mistrust, discrimination, stigma, cost, and privacy concerns. Thus, interventions to improve dual self-testing uptake and linkage to PrEP and/or HIV/syphilis treatment following a self-test are urgently needed for South African women. Yet, we must first address 3 critical gaps in our knowledge, including women’s needs/preferences on: self-test access and uptake; logistical support needed to correctly use/interpret self-tests; and linkage to and uptake of PrEP and/or HIV/syphilis treatment following self-tests. Using the INSTI Multiplex, a dual blood-based HIV/syphilis test that delivers results in 1-minute, we use mixed-methods to inform these knowledge gaps and draft a dual self-testing and linkage to care intervention for women. Research takes place in Johannesburg, South Africa, brings together an established research team and community advisory board, and is informed by the Mensch Model; work will occur in 3 stages. In Stage 1, we will conduct in-depth interviews with: N=15 women and N=15 healthcare workers. Women will use INSTI Multiplex in front of a study team member to provide immediate feedback on logistical support needed to test/interpret results; they will also discuss preferences on test access, and linkage. In Stage 2, we will enroll N=80 women to complete self-administered web-based surveys on their mobile phones. Surveys are developed from IDI themes and will identify women’s preferred intervention strategy to address each domain. We will engage a data convergence process to ensure that quantitative/qualitative findings inform one another. We will then draft the intervention using the 4 COM-B Intervention Function Matrix. In Stage 3 we will engage an intervention development workgroup consisting of at least n=5 members from each of the following groups: community advisory board, women, healthcare workers. We will present them draft intervention to further develop/refine in 4 meetings of 90-minutes, each. The product will be tested in a future NIH R01.