A randomised controlled trial to evaluate adding self-administered oral HIV testing as a choice in clinic and non-clinic settings to increase HIV testing uptake among truck drivers in Kenya
Overview:
A pilot programme to introduce self-administered oral HIV testing to truck driver clients of two North Start Alliance clinics in Kenya in two settings — in the clinic and the clients’ home.
Objectives:
The objective of this study is to determine whether self-administered oral HIV testing, in or outside of a clinic setting, has the potential to reduce a number of barriers to HIV testing faced by truck drivers, therefore providing an acceptable option for people in mobile professions who do not use existing HIV testing and counselling services.
The ability to test by one’s self may allay concerns about confidentiality. Self-administered testing in a clinic setting may reduce the need for healthcare staff since staff is no longer performing the test and shorten clinic waiting time; for those using the test outside of a clinic setting, there may be the added benefit of reduced travel time and cost, although some travel may be required to obtain the test kit. People who self-test may experience a greater sense of autonomy and control, which may address some of the fatalistic views truck drivers have, by giving them a stronger sense of agency and self-efficacy in addressing their own healthcare needs. Furthermore, if the HIV test can be used outside of the clinic, truck drivers could pick up a test kit at a roadside clinic and test at home, which may be a less stressful environment, where they have access to their network of family and friends should they choose to discuss their testing experience and results with someone they trust.
Methodological approach:
Randomise 300 truck driver clients on a 1:1 ratio to either a standard provider-administered HIV testing arm or an arm. Clients can choose between standard or supervised self-administered oral HIV testing (OraQuick) in the clinic, with professional staff available to conduct pre and post-test counselling, explain the testing process and answer questions during self-administration of the test. Clients have the choice to view the test results (available 20-40 minutes later) by themselves or with a healthcare professional to help interpret the results. Thus, clients have the option to keep their test results completely confidential, although disclosure of test results is encouraged during the post-test counselling session.
Clients who choose the oral self-administered HIV test in the clinic are invited to return to the clinic 3-6 months later to pick-up a second oral HIV test for self-administered use outside of the clinic (i.e. at home or in another private place where the client feels comfortable). Clients are told that they must use the test within 3 days of picking it up, and instructed to send a text message to the provided number after completing the test in order to receive a call-back for post-test counselling and referrals over the phone (again, clients are encouraged but not required to disclose the test results). In addition, clients are told that should they have any questions, concerns, they can text a counsellor at any time and have their counsellor call them back to talk. By offering a choice of testing methods and settings, we hope to address some of the barriers to HIV testing among truck drivers, such as concerns about privacy and confidentiality, clinic wait time and the challenge of linkage to appropriate services when testing at roadside clinics far from home. The provision of choices may also change the question from whether or not to test, to how to test, in the minds of clinic clients and thus increase HIV testing uptake.