Auteurs:
Alain Amstutz (Basel | CH)
Thabo Ishmael Lejone (Butha-Buthe | LS)
Lefu Khesa (Mokhotlong | LS)
Josephine Muhairwe (Maseru | LS)
Bienvenu Lengo Nsakala (Butha-Buthe | LS)
Moniek Bresser (Basel | CH)
Mathebe Kopo (Butha-Buthe | LS)
Mpho Kao (Mokhotlong | LS)
Fiona Vanobberghen (Basel | CH)
Fabrizio Tediosi (Basel | CH)
Thomas Klimkait (Basel | CH)
Manuel Battegay (Basel | CH)
Tracy Renée Glass (Basel | CH)
Niklaus Daniel Labhardt (Basel | CH)
Background
Reaching high HIV testing coverage during home-based testing campaigns in sub-Saharan Africa, and engaging those newly diagnosed to long-term HIV care, remains challenging. This is particularly difficult in remote areas where access to health facilities is a major impediment. Two interlinked cluster-randomized trials, HOSENG (HOme-based SElf-testiNG) and VIBRA (VIllage-Based Refill of Antiretroviral therapy (ART)), explore innovative interventions to improve testing coverage and subsequent engagement in care in rural Lesotho, Southern Africa. Together, they constitute the GET ON (GETting tOwards Ninety) research project, that is designed to reach the UNAIDS 90-90-90 targets, and in line with the UNAIDS strategy to recruit more than 2 million community health workers in Africa.
Methods
The HOSENG trial (NCT03598686) measures the effect of secondary distribution of oral HIV self-tests during home-based testing on testing coverage within 120 days after the campaign. In intervention clusters (i.e. villages), self-tests are left for household members who are absent or decline testing. Distributed self-tests are then followed up by trained lay community health personnel known as village health workers (VHWs). A long-standing public sector cadre of VHW already exists in Lesotho with more than 4000 VHWs currently successfully operating in all districts.
The VIBRA trial (NCT03630549) assesses a new decentralized ART delivery model that builds on the VHW program and uses SMS technology. It enrolls individuals found HIV positive and not on ART during the HOSENG trial. In control clusters, participants are offered same-day ART initiation with follow-up at the clinic. In intervention clusters, participants are offered same-day ART with the possibility of further follow-up by the nearby trained VHW. Moreover, they may receive automatically generated coded SMS with adherence reminders or viral load results.
Results
Overall recruitment will successful be closed on May 31, 2019. By September we will be able to present final results from the HOSENG trial and preliminary results from the VIBRA trial.
Conclusions
The HOSENG trial results will inform the feasibility and additive effect of secondary distribution of self-tests during home-based HIV testing in rural Africa. The VIBRA trial will be the first randomized trial assessing follow-up of patients by medical lay-workers directly after home-based same-day ART initiation.