GHES LMIC Fellow 2018-2019
FELLOWSHIP SITE: Kenyatta National Hospital, Nairobi, Kenya
U.S. INSTITUTION: YALE UNIVERSITY
Project Title: Implementing a Peer-led HIV Self-testing Intervention Targeting Young People in a High-risk, High HIV Prevalence Fishing Community in Rural Uganda: a Feasibility Study
HIV testing, linkage to HIV care and viral suppression remain largely low among young people (15-24), despite the fact that nearly one-third of new HIV infections occur in this age-group. According to preliminary results from the Uganda Population-based HIV Impact Assessment Survey, HIV prevalence is nearly three times higher in men and women aged 20-24 compared to those aged 15-19 years. HIV incidence is equally higher among young people, with some studies reporting HIV incidence in the upwards of 10 per 1000 person years. Studies show that individuals aged 15-24 years are less likely to be aware of their HIV status, to be enrolled in HIV care and to have a suppressed viral load when compared to HIV-positive persons aged 30 years or older. Several reasons have been cited to explain this phenomenon including perceptions of low risk of HIV infection, stigma around HIV testing, long waiting times at HIV testing clinics, and concerns around confidentiality of HIV test results by health workers. These findings call for a need to design interventions that can mitigate these barriers while improving HIV testing and linkage to HIV care among young people.
Recent evidence suggests that HIV self-testing (HIVST), an approach where individuals can collect their own specimen, perform a test and interpret the results in a private environment without the assistance of a healthcare professional, can improve HIV testing rates among young people. However, few interventions have specifically targeted young people with HIVST interventions. We propose to implement a study to assess the effect of a peer-led HIV self-testing intervention on HIV testing rates and linkage to HIV care among young people living in one of the fishing communities along the shores of Lake Victoria in rural Uganda. This study will be implemented in two phases: in phase 1, we will assess the feasibility of implementing a peer-led, HIV self-testing intervention among young people living in Kasensero fishing community; and in phase 2, we will use the findings from the feasibility study to design and implement a pilot HIV self-testing intervention aimed at assessing the acceptability of oral fluid HIV self-testing kits distributed through different HIV self-testing distribution models. This project is restricted to phase 1 of this study.