Background: Secondary distribution of HIV self-tests by women to their male partners has been shown to increase male partner testing and is being implemented in several countries. There are limited data, however, on the extent to which this approach results in identification of HIV-positive partners or changes in sexual decision-making.
Methods: We examined 6-month follow-up data from the intervention arm of an ongoing randomized trial in 66 community clusters in Siaya County, Kenya (NCT03135067). HIV-negative women aged ≥18 years who self-reported ≥2 partners in the past month were eligible. Participants received 5 oral fluid-based self-tests at enrollment and additional self-tests, as needed, at 3-month intervals. Follow-up data were collected at 6 months on overall self-test distribution to sexual partners, partner test results, and general changes in sexual behavior. Participants also reported specifically on self-test distribution and sexual behavior in their 3 most recent transactional sex encounters.
Results: Among 1,063 participants in the intervention arm, 664 (66.6%) had completed 6-month follow-up by January 14, 2019 (all participants will be contacted by April 2019). Participants'' average age was 27 years and 71% reported sex work as an income source. Over 6 months, participants on average received 8 self-tests and distributed 3.7 to sexual partners. A total of 128 partners had reactive self-tests, implying HIV-positivity of 5.3% among self-tests distributed and 0.19 HIV-positive partners per participant. Among all participants, 13.1% declined to have sex and 10.8% used a condom with at least one partner who self-tested HIV-positive or refused self-testing. In 1,375 transactional sex encounters, 915 (67%) included an offer of a self-test to the partner. HIV status was ascertained in 819/851 (96%) of encounters where partners accepted self-tests. Condom use was significantly higher with transactional partners who obtained an HIV-positive versus HIV-negative result (88.5% vs. 59%, p< 0.01) or versus those who refused to self-test (79.7% vs. 59%, p< 0.01).

[Sexual behavior of participants based on their male partners? self-testing outcomes]


Conclusions: Providing high-risk women with multiple self-tests facilitated partner testing and identification of HIV-positive partners. Partner self-testing outcomes, including refusal to accept self-tests, enabled women to engage in safer sexual behavior.

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