Increased HIV testing by men in sub‐Saharan Africa is key to meeting UNAIDS 2025 testing targets. Secondary distribution of HIV self‐testing (HIVST) kits by pregnant women attending antenatal care to male partners has been shown to increase testing among African men. A detailed understanding of how women and male partners manage the distribution and use of HIVST and subsequent linkage to clinic‐based follow‐up can inform implementation and scale‐up efforts.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jia2.26050

How pregnant women living with HIV and their male partners manage men's HIV self‐testing: qualitative analysis of an HIVST secondary distribution process in Kampala, Uganda

HIV self-testing (HIVST) refers to the process in which individuals collect their own specimens (e.g. blood, saliva and urine), perform the test and interpret the results at a convenient time and place [1]. HIVST has been recognized as an innovative and promising approach to increase testing uptake, expand the HIV testing rate and enhance HIV testing coverage [1, 2]. Moreover, a large body of HIVST programmes and research worldwide also proved the feasibility, acceptability and effectiveness of HIVST in HIV prevention [1, 3]. Hence, the World Health Organization (WHO) recommended HIVST as the alternative and promising way to decentralize HIV testing and further increase the uptake of HIV testing, especially in lowand middle-income countries [4]. More importantly, the experiences learned from HIVST programmes can be utilized to facilitate other sexually transmitted infection (STI) prevention programmes. Although the STI epidemic has become a global public health issue, it was often overlooked and underfunded. Given the advantages of selftesting, scholars and health practitioners proposed STI selftesting as an alternative way to facilitate the STI testing rate and coverage outside clinical settings. However, previous selftesting research and implementation programmes focused on HIVST or STI self-testing separately [5], which lost the opportunity to promote HIV and STI testing simultaneously. Here, we advocate that integrating STI self-testing with HIVST may be useful for expanding STI testing. First, the high feasibility of HIVST has opened a pathway for STI self-testing. HIVST is easy, convenient [6] and less stigmatized [7]. By integrating STI self-testing with HIVST, the demand generated by HIVST can be leveraged to improve STI testing coverage. For example, a clinical trial conducted in China demonstrated that rapid dual self-testing for HIV and syphilis expanded syphilis testing uptake among men who have sex with men (MSM) in China [8]. Studies in several other countries (e.g. the United States and Australia) also confirmed this finding. As a result, the WHO recommended the dual HIV/syphilis rapid test as the alternative option to expand HIV and syphilis testing rate [4]. Second, the integration would be more cost-effective than HIV or STI self-testing alone. By integrating programmes, resources can be leveraged for multiple STI testing instead of HIVST alone. Since HIVST alone is already a cost-effective strategy for promoting HIV screening [9], integrating STI selftesting with HIVST would be more cost-effective. With the increasing burden of syphilis and other STIs globally, there is a strong need to promote STI testing [6]. The HIV-STI integrated model should be affordable in diverse settings, especially in lowand middle-income countries. Third, the integrated self-testing model can decentralize STI testing, improving the coverage of STI testing. Traditional STI testing mainly relies on clinic testing, which may be more stigmatized, centralized and hard to access for at-risk individuals [8]. With the shifting budgets and closure of clinics due to COVID-19 and other issues, a lack of access to STI testing may further exacerbate the STI epidemic [10]. This has been demonstrated in a study conducted in the United States [11]. To address this problem, decentralized STI testing and promoting a people-centred STI testing strategy is essential, while integrating STI self-testing with HIVST can empower and facilitate routine STI tests. However, there are a few things that need to be taken into consideration before the scale-up of an integrated HIV-STI self-testing model.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jia2.26138

Promoting STI self‐testing through HIV self‐testing

The goal of this review is to highlight and interpret recent trends and developments in the diagnosis, treatment, and prevention of HIV vertical transmission from a clinical perspective.Universal third-trimester retesting and partner testing may better identify incident HIV among pregnant patients and result in early initiation of antiretroviral therapy to prevent vertical transmission. The proven safety and efficacy of integrase inhibitors such as dolutegravir may be particularly useful in suppressing viremia in pregnant persons who present late for ART treatment. Pre-exposure prophylaxis (PrEP) during pregnancy may play a role in preventing HIV acquisition; however, its role in preventing vertical transmission is difficult to elucidate. Substantial progress has been made in recent years to eliminate HIV perinatal transmission. Future research hinges upon a multipronged approach to improving HIV detection, risk-stratified treatment strategies, and prevention of primary HIV infection among pregnant persons. 

The End Is in Sight: Current Strategies for the Elimination of HIV Vertical Transmission

Background HIV self-testing (HIVST) is a promising strategy to increase awareness of HIV status among sub-Saharan African (SSA) men. Understanding user perspectives on HIVST secondary distribution from pregnant women attending antenatal care (ANC) to their male partners is crucial to optimizing delivery strategies. Methods We sampled pregnant women attending ANC without their partners and purposively oversampled pregnant women living with HIV (PWHIV) to understand their unique views. We recruited male partners after obtaining contact information from women. We conducted 14 focus group discussions and 10 in-depth interviews with men and pregnant women. We assessed acceptability of HIVST secondary distribution, barriers, facilitators, and interventions to increase HIVST uptake. Results Participants felt that HIVST secondary distribution was acceptable, particularly for women in stable relationships. However, many expressed concerns about accusations of mistrust, relationship dissolution, fear of discovering serodifference, and lack of counseling associated with HIVST. PWHIV reported hesitation about secondary distribution, citing fears of unintended HIV status disclosure and abandonment resulting in financial hardship for themselves and their infant. Some participants preferred that providers contact men directly to offer HIVST kits instead of distribution via women. Participants reported that community sensitization, availability of phone-based counseling, male clinic staff, extended clinic hours, and financial incentives could increase men’s HIVST use and linkage to care. Conclusion Participants expressed high interest in using HIVST, but secondary distribution was not universally preferred. We identified potential strategies to increase HIVST acceptability, particularly among PWHIV and those in unstable partnerships which can inform strategies to optimize HIVST distribution.

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Pregnant women and male partner perspectives of secondary distribution of HIV self-testing kits in Uganda: A qualitative study

“Him Leaving Me – That is My Fear Now”: A Mixed Methods Analysis of Relationship Dissolution Between Ugandan Pregnant and Postpartum Women Living with HIV and Their Male Partners

Faith Naddunga

Papers

How pregnant women living with HIV and their male partners manage men's HIV self‐testing: qualitative analysis of an HIVST secondary distribution process in Kampala, Uganda

Pregnant women and male partner perspectives of secondary distribution of HIV self-testing kits in Uganda: A qualitative study

“Him Leaving Me – That is My Fear Now”: A Mixed Methods Analysis of Relationship Dissolution Between Ugandan Pregnant and Postpartum Women Living with HIV and Their Male Partners