Population Council Research that makes a difference

Health care workers (HCWs) are at risk for HIV due to occupational and behavioral factors. Yet many do not get tested for HIV because of concerns about confidentiality and stigma. The Population Council piloted and evaluated the acceptability and feasibility of an intervention, "Knowing Myself First," to offer free, home-based HIV self-testing (HST) for HCWs in Kenya.

The intervention targeted district-level hospital clinicians and counselors, including doctors, nurses, laboratory technicians, counselors, and social workers. HCWs interested in self-testing were provided pre-HST information sessions in small groups and received oral HIV test kits free-of-charge for themselves and their partners to use at home. Post-HST counseling and information were offered by mobile and site-based HIV counselors, as well as via a toll-free counseling hotline.

The pilot study demonstrated that HIV self-testing can be successfully implemented among hospital-based HCWs, and, given the high demand for HST, self-test kits must be made available on a larger scale. Results informed the scale-up of the intervention to seven other district-level hospitals across Kenya.

The main intervention study was conducted from December 2009 to January 2010. The postintervention survey to assess uptake was conducted in January and February 2010. Overall, 765 health workers were eligible and were interviewed among all hospitals.

When HST kits were offered to HCWs in the seven participating hospitals, acceptance and use of the kits were high. Approximately nine out of ten health workers (89 percent) who attended the information session on HST took the test with them after the session, and of those who took the test kits, the majority tested themselves (85 percent). Most (72 percent) tested themselves within one day of receiving the HST kit. The majority (64 percent) of HCWs with partners indicated that their partners used the HST kits to test themselves, and among them, almost all (96 percent) tested within one week of receiving the test kit. Qualitative results revealed that while many of the HCWs and their partners tested together, couples who did not test together still revealed their test results to their partners.

The study clearly indicates that HCWs see the urgency to test themselves for HIV. The study also found that HST kits were desired by the partners of HCWs. In this implementation study, we found that the greater hurdle to uptake of self-testing was getting the HCWs to attend the HST informational sessions rather than session attendees accepting the HST kits. Another major gap was the need for post-test counseling and follow-up care and support services for health workers who test HIV-positive.

Recommendations

If the HST program is implemented for HCWs in a facility, the management should resolve scheduling issues so that HCWs are given the opportunity to attend the HST sessions. Further, provision and promotion of post-test counseling or support systems are needed to provide support for those found to be HIV-positive from the HST test, as well as for those found to be HIV-negative, so that they can remain HIV-negative. Implementation and scale-up of this program should be considered based on the lessons learned from this study.