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• W4386594903 abstract "Objective: More than one in four adults over 40 with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing strategies for middle-aged and older adults in rural South Africa. Design: 2,963 individuals in the ‘Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)’ cohort study were randomized 1:1:1 to one of three types of home-based and home-delivered HIV testing modalities: (1) rapid testing with counseling; (2) self-testing, and (3) both rapid testing with counselling and self-testing. Method: In modified Poisson and OLS regression analyses, we estimated the treatment effects on HIV testing and HIV testing frequency at about one year after delivery. Finally, we assessed the potential adverse effects of these strategies on the secondary outcomes of depressive symptom as assessed by the CESD-20, linkage to care, and risky sexual behavior. Results: There were no significant differences in HIV testing uptake or testing frequency across groups. However, respondents in the self-testing treatment arms were more likely to shift from testing at home and a facility (ST: RR 0.86, 95% CI 0.76 – 0.97; ST+RT+C: RR 0.85, 95% CI 0.75 – 0.95) to testing only at home (ST: RR 1.67, 95% CI 1.17 – 2.39; ST+RT+C: RR 1.62, 95% CI 1.13 – 2.32) – suggesting a revealed preference for self-testing in this population. We also found no adverse effects of this strategy on linkage to care for HIV and common comorbidities, recent sexual partners, or condom use. Finally, those in the self-testing only arm had significantly decreased depressive symptom scores by 0.58 points (95% CI: -1.16 – -0.01). Conclusions: We find HIV self-testing to be a safe and seemingly preferred home-based testing option for middle-aged and older adults in rural South Africa. This approach should be expanded to achieve the UNAIDS 95-95-95 targets." @default.
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• W4386594903 date "2023-09-06" @default.
• W4386594903 modified "2023-09-29" @default.
• W4386594903 title "Home-based HIV testing strategies for middle-aged and older adults in rural South Africa: a randomized controlled trial" @default.
• W4386594903 doi "https://doi.org/10.1097/qad.0000000000003698" @default.
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