Valuation of impact of targeted community based HIV self-testing (HIVST) on uptake of antiretroviral therapy (ART) in health care facilities in Blantyre urban
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Date
2021-09-06
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Kamuzu University of Health Sciences
Abstract
In 2016, the World Health Organization (WHO) recommended HIV self-testing
(HIVST) as a safe, accurate and effective way to reach people who may not test
otherwise.5 Studies have demonstrated that HIVST increases the uptake of HIV testing
and is acceptable and feasible in a range of populations and settings,
6–8
however,
important questions regarding linkage and impact of HIVST on ART remain.
Continued scale up of HIVST hinges on strong evidence of its impact on achieving the
second 90 and 95 treatment targets and the attainment of HIV epidemic control.
A retrospective, quasi experimental study design used for evaluating longitudinal
effects of interventions–the interrupted time series (ITS) study design will be
conducted. The ITS will utilize ART data captured in MOH ART registers from
Bangwe, Limbe and Ndirande Health Centers aggregated at time points, 12 months
before and after start of community based HIVST program in Blantyre city.
Broadly the study will investigate the impact of community based HIV self-testing
implemented routinely at scale on ART uptake in Blantyre urban health facilities.
Specifically the study will;
1. Compare ART initiations for clients’ ≥16 years and above at three selected
treatment facilities in Blantyre urban 12 months before and after scale-up of HIVST
distribution program.
2. Compare the percentage of clients ≥16 years and above initiating ART with
advanced and severe HIV_ (WHO stage 3 and 4 respectively) and those with current
TB before and after scale-up of HIVST distribution program.
3. Determine the proportion of ART initiations for clients ≥16 years and above
attributable to HIVST as initial test establishing HIV+ status at three selected
treatment facilities in Blantyre urban 12 months after scale up of HIVST
distribution program.
Data for clients ≥ 16 years and above, newly initiated on ART for the period of May
2017 to May 2019, will be abstracted from ART registers to study-specific data
abstraction form. Counterfactuals will be constructed via a projection of the trendbefore the intervention was introduced into the time period after it was introduced.
Level and trend of the pre-intervention segment will serve as control for the post intervention segment.9,10 Segmented regression analysis will be the main statistical
method for estimating HIVST effect on ART initiation. For objective number 3, a
questionnaire will be administered on a sample of 376 clients drawn from clients ≥16
years and above initiating ART 12 months after scale up of HIVST distribution program
(i.e. between June 2018 to May 2019). Descriptive statistics will be used to calculate
proportions; a t-test will check the statistical significance in the proportions in order to
tell the effect of change from the intervention.
The study expects to find significant increase in proportion of clients initiating ART
and better clinical status at initiation (WHO clinical stage and TB status) after
introduction of HIVST. Results of the study will be published and copies will be
submitted to College of Medicine in partial fulfilment for the award of Masters in Public
Health.