Background: Index partner testing is critical for reaching UN 90-90-90 goals. Partner referral slip (PRS) is the primary strategy for testing partners throughout sub-Saharan Africa, however, index testing remains low. HIV self-testing (HIVST) may overcome barriers to testing, however, there are no data on whether HIV-positive clients would be comfortable delivering HIVST kits to their partners. We examined HIV-positive clients'' perceived acceptability of HIVST as a strategy for index partner testing in Malawi.
Methods: The study was nested within a cluster randomized trial examining HIVST distribution to outpatient clients within health-facilities. Exit surveys were conducted with outpatient clients ≥15 years of age at 15 facilities in Central/Southern Malawi. Clients who self-reported previously testing HIV-positive and having a sexual partner in the past 12-months completed a separate survey module on client perceptions of index partner testing strategies.
Results: 452 clients (8% of RCT participants) completed the index testing module. Clients'' willingness to deliver index testing materials to partners increased by 11% when presented with the option to deliver HIVST kits over PRS. Overall, 65% of clients preferred delivering HIVST kits over PRS. Among those uncomfortable to deliver HIVST, common reasons include fear of partner responses (men:62%, women:60%) and feeling uncomfortable explaining HIVST to partners (men:24%, women:33%). When asked whether clients believed their partner would actually test for HIV through index testing, HIVST was associated with an 18% increase in anticipated testing compared to PRS. Overall, 69% of clients believed their partner would prefer testing with HIVST over PRS. HIVST was believed to decrease disparities in testing for male partners. HIV-positive women were less comfortable delivering PRS to their partners than HIV-positive men (AOR:1.86, p=0.03), however this gender-difference becomes insignificant when introducing HIVST (AOR:1.72, p=0.14). Similarly, male partners were believed to be less likely than female partners to actually test through PRS (AOR:1.60, p=0.04), and again, this gender-difference becomes insignificant when introducing HIVST (AOR:1.23, p=0.41).
Conclusions: Delivery of HIVST kits to sexual partners was perceived as acceptable among HIV-positive clients in Malawi. Importantly, HIVST may close gender-specific gaps in male partner testing. Additional studies are needed to assess actual use and linkage to care.



[Table. Characteristics of HIV-positive participants and their perceived acceptability of partner-delivered HIV self-test kits in Malawi]