Skip to main content
SearchLoginLogin or Signup

Review 2: "What Role do Community-level Factors Play in HIV Self-testing Uptake, Linkage to Services and HIV-related Outcomes? A Mixed Methods Study of Community-led HIV Self-testing Programmes in Rural Zimbabwe"

The majority of reviewers found this preprint potentially informative, but recommend that the authors include more clarification on specific sections. 

Published onJun 14, 2024
Review 2: "What Role do Community-level Factors Play in HIV Self-testing Uptake, Linkage to Services and HIV-related Outcomes? A Mixed Methods Study of Community-led HIV Self-testing Programmes in Rural Zimbabwe"
1 of 2
key-enterThis Pub is a Review of
What role do community-level factors play in HIV self-testing uptake, linkage to services and HIV-related outcomes? A mixed methods study of community-led HIV self-testing programmes in rural Zimbabwe
What role do community-level factors play in HIV self-testing uptake, linkage to services and HIV-related outcomes? A mixed methods study of community-led HIV self-testing programmes in rural Zimbabwe
Description

ABSTRACT Community-led interventions, where communities plan and lead implementation, are increasingly adopted in public health. We explore what factors may be associated with successful community-led distribution of HIV self-test (HIVST) kits to guide future service delivery.Twenty rural communities were supported to implement month-long HIVST kit distribution programmes from January-September/2019. Participant observation was conducted to document distribution models. Three months post-intervention, a population-based survey measured: self-reported new HIV diagnosis; self-reported HIVST uptake; self-reported linkage to post-test services; and viral load. The survey included questions for a composite measure of ‗community cohesion‘. Communities were grouped into low/medium/high based on community cohesion scores. We used mixed effect logistic regression to assess how outcomes differed by community cohesion. In total, 27,812 kits were distributed by 348 distributors. Two kit distribution models were implemented: door-to-door distribution only or distribution at venues/events within communities. Of 5,683 participants surveyed, 1,831 (32.2%) received kits and 1,229 (67.1%) reported using it; overall HIVST uptake was 1,229/5,683 (21.6%). Self-reported new HIV diagnosis increased with community cohesion, from 32/1,770 (1.8%) in the lowest cohesion group to 40/1,871 (2.1%) in the medium group, adjusted odds ratio (aOR) 2.94 (1.41-6.12, p=0.004) and 66/2,042 (3.2%) in the highest cohesion group, aOR 7.20 (2.31-22.50, p=0.001). Other outcomes did not differ by extent of cohesion.HIVST kit distribution in high-cohesion communities was associated with seven times higher odds of identifying people with new HIV diagnoses, suggesting more cohesive communities may better identify those most at risk of undiagnosed HIV. Communities can learn from and adopt these participatory community-led approaches to intervention planning and implementation, which may foster cohesion and benefit public health programmes.

RR:C19 Evidence Scale rating by reviewer:

  • Potentially informative. The main claims made are not strongly justified by the methods and data, but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt. Decision-makers should consider this evidence only with a thorough understanding of its weaknesses, alongside other evidence and theory. Decision-makers should not consider this actionable, unless the weaknesses are clearly understood and there is other theory and evidence to further support it.

***************************************

Review: HIVST kit distribution in high-cohesion communities was associated with seven times higher odds of identifying people with new HIV diagnoses. This study from rural Zimbabwe evaluated community level factors associated with HIV self-testing uptake and linkage to services. Community cohesion, evaluated by research staff, was associated with higher uptake of HIVST and diagnosis of HIV. Participatory community-led approaches to intervention planning may foster cohesion and benefit public health programs.

This is an interesting study of HIVST in rural Zimbabwe, including an evaluation of community cohesion as a predictor of HIVST "success". There are several areas that could be strengthened in the report:

  1. In the abstract, the authors should include what variables were included in the adjusted logistic regression models.

  2. In the introduction for line 93, the authors should include the years being analyzed and the number/referral period for increases in ART.

  3. In the methods, the authors should specify if they excluded people who were living with HIV from the study intervention?

  4. What is the primary outcome and what was the sample size required for this outcome? Seems that there were several outcomes (testing uptake, linkage, PrEP/VMMC and positivity, self-reported). 

  5. The authors should specify the limitations of self-reported outcomes. For example, the under or over-reporting of which variables? 

  6. Community cohesion was associated with increase in self-reported new HIV diagnosis. The authors should clarify if they adjusted for underlying HIV incidence or prevalence differences or if there were no differences in underlying HIV in each community.

  7. In discussion, authors mention that the distribution of HIVST is feasible and acceptable, though this was not defined, nor was it an outcome. The authors should define acceptability and feasibility prior to presenting this finding in the conclusion.

Community cohesion in rural settings in Zimbabwe was associated with an increase in self-reported new HIV diagnoses. More cohesive communities may be better able to identify those most at risk of undiagnosed HIV infection and provide HIVST and other services in an environment where HIV can be discussed more freely.

Comments
0
comment
No comments here
Why not start the discussion?