Investigator(s)
| Submitter |
Lekey Khandu Curtin University, Perth, Western Australia 6102, Australia Lekey Khandu 
|
| Principal Investigator |
Lekey Khandu Curtin University of Technology Perth, Western Australia 6102, Australia Lekey Khandu
|
| Co-Investigator(s) |
Jonathan Hallett Curtin University of Technology Perth, Western Australia 6102, Australia Jonathan Hallett
|
| Co-Investigator(s) |
Gemma Crawford Curtin University of Technology Perth, Western Australia 6102, Australia Gemma Crawford
|
| Co-Investigator(s) |
Justine Leavy Curtin University of Technology Perth, Western Australia 6102, Australia Justine Leavy
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| Co-Investigator(s) |
Daniel Vujcich Western AIDS Council (WAAC) Western Australia, Australia 6102 Daniel Vujcich
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Title(s) and abstract
| Scientific title | Enhancing the use of HIV self-testing for reaching the sexual and drug-injecting partners of people diagnosed with HIV and other undiagnosed key populations in low-middle-income countries. |
| Public title | Improving Access to HIV Self-Testing for Partners and Key Populations in Low-to-Middle-Income Countries |
| Background | Testing for Human Immunodeficiency Virus (HIV) is the gateway to diagnosis and linkage to care, treatment, and adherence support. Improving access to HIV testing is critical to ending the AIDS epidemic. A major challenge to accessing HIV testing is HIV-related stigma and discrimination and its associations with sexual and gender minority populations. As a result, a considerable proportion of people living with HIV among key populations, like men who have sex with men, transgender persons, and female sex workers, are diagnosed late with consequences for treatment and care. Stigma and discrimination are barriers to accessing HIV prevention services by key populations in many countries across the globe, including Bhutan. In Bhutan, key populations are at elevated risk for HIV acquisition. Still, there is extremely low HIV testing uptake, falling far short of national coverage targets to bridge the current case detection gap of 40%. There is some evidence that HIV self-testing (HIVST) may be one strategy to expand HIV testing access, particularly for stigmatized populations, thereby enhancing HIV diagnosis and reducing the current case detection gap. HIVST provides an opportunity for stigmatized key populations to test themselves anonymously without having to visit health centres. Adding HIVST to partner notification/contact tracing holds great promise for early diagnosis and timely treatment. Although index testing to partner notification has existed since the beginning of the HIV epidemic, now is the time to re-examine its role in getting to zero HIV infections. As new HIV cases become scarce, identifying the source and spread of infections stemming from people diagnosed with HIV may become increasingly dependent upon partner notification/contact tracing. |
| Objectives | Aim and Objectives The research aim is to determine the feasibility and acceptability of HIVST to reach untested and undiagnosed sexual and drug-injecting partners of people newly diagnosed with HIV and other key populations to accelerate timely testing, diagnosis, and linkage to treatment. Research Objectives are to: 1. Identify the global use, challenges, and successes of HIVST among key populations like men having sex with men, transgender persons, and female sex worker populations. 2. Assess the factors associated with low uptake of existing HTC services by these key populations and their willingness to distribute HIVST to the sexual and drug-injecting partners of newly diagnosed PLHIV and other undiagnosed key populations. 3. Identify barriers, facilitators, and mechanisms to deliver HIVST for HIV index partners and partners of undiagnosed key populations, and link persons testing positive to timely confirmation, care, and treatment, as reported by diagnosed PLHIV, other key populations and health care providers. 4. Provide recommendations to develop strategies for index testing to partner notification services using HIVST to close the current case detection gap. |
| Study Methods | Methods Study design: A mixed method is proposed. The qualitative method will probe the barriers and facilitators of HIV testing and potential HIVST among newly diagnosed persons with a focus on the provision of HIVST to partners. The best methods to deliver HIVST to partners and to obtain results will be determined. Quantitative surveys of key populations will be undertaken to characterize barriers to HIV testing at conventional sites and willingness to use HIVST for themselves and their partners. The focus group discussion and in-depth interview guide questions, including a survey questionnaire, will be developed following the systematic review. Setting: The study will be conducted in Thimphu, Chukha (Phuentsholing) and Mongar from November-December 2024. Measures: Key measures will be indicators aligned with answering the objectives, namely the prevalence of different barriers to traditional facility-based testing, and levels of willingness and acceptability of HIVST for partner testing among diagnosed PLHIV and other undiagnosed key populations. Data analysis: Thematic analysis will be used to analyse qualitative data. Descriptive and logistic regression analyses, using SPSS version 8, will be carried out to analyse quantitative findings. Ethical considerations: The proposal will be reviewed by the REBH and then the HREC of Curtin University. Participants will provide informed consent. Participants’ confidentiality will be maintained at all stages of the study. |
| Expected outcomes and use of results | Expected Outcomes 1. Detailed global insight into the use, challenges, and successes of HIV self-testing (HIVST) for index testing to partner notification among PLHIV and key populations. 2. Identification of factors leading to the low uptake of existing HIV testing services among key populations. 3. Assessment of the willingness of key populations to distribute HIVST kits to sexual and drug-injecting partners of newly diagnosed and undiagnosed individuals. 4. Identification of barriers and facilitators for delivering HIVST and linking those who test positive to timely confirmation, care, and treatment. 5. Development of strategic recommendations to improve index testing and partner notification services using HIVST to close the current case detection gap. Use of Results 1. Guide policymakers and program designers on integrating HIVST for index testing and increasing uptake among key populations. 2. Offer healthcare providers best practices for effective HIVST implementation and service delivery. 3. Develop educational campaigns to promote HIVST adoption for testing partners of diagnosed and undiagnosed individuals. 4. Implement strategies to close the case detection gap. |
| Keywords | Human immunodeficiency virus, self-testing, key population, men having sex with men, female sex workers, people living with HIV. |
Research Details
| Student research | Yes |
| Institution: Curtin University of Technology | |
| Academic degree: Ph.D. | |
| Supervisor of the student(s) | |
| Full Name and title: Jonathan Hallett | |
| Email: Jonathan@curtin.edu.au | |
| Start Date | 01-Apr-2023 |
| End Date | 31-Mar-2027 |
| Key Implementing Institution | Curtin University of Technology |
| Multi-country research | No |
| Nationwide research | No |
| Bhutan, Bhutan, Bhutan | |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | HIV/AIDS |
| Involves human subjects | Yes |
| Other (Mixed methods) | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Approved |