Acceptability and Feasibility of Unsupervised HIV Self-Testing Among Networks of Men in Tanzania

PROJECT SUMMARY/ABSTRACT Career Goal: My career goals are to secure a tenure-track faculty position in a university where I can develop a research program focusing on HIV prevention for networks of men at risk for HIV. In working towards this goal, my NIH Pathway to Independence Award (K99/R00) will provide me the training and protected time to develop an intervention to promote HIV self-testing (HST) among men in Tanzania. Career Development: The training I will receive during the K99/R00 will allow me to transition from conducting secondary data analyses to being able to develop and implement interventions and do primary data collection and analysis on the influence of men's networks on their willingness to self-test and confirm their HIV test results. During the K99 phase, my goals are to learn: 1) methods in social networking analyses, mixed methods, longitudinal, and multilevel model designs and analyses; 2) to design, implement, and evaluate HIV prevention interventions; and 3) increase my knowledge of HIV testing diagnostics. Research Project: In sub-Saharan Africa, men have a lower HIV testing rate than women for several reasons, including: men interact less with the health care system; men fear losing respect within their social networks if seen at an HIV testing site; and men perceive a lack of privacy and confidentiality at healthcare clinics. The OraQuick In-Home HST offers an alternative testing approach for men that is unsupervised, thus allowing for privacy. However, HST does not provide a definitive HIV diagnosis. A blood-based HIV test is needed to confirm the diagnosis. For this reason, concerns remain about the best strategies to ensure men will seek confirmatory blood-based HIV testing and receive the necessary post-test services to initiate the linkage to care process in case of a positive result. As with facility- based HIV testing, social networks may affect men's willingness to self-test for HIV. In addition, the perceived lack of confidentiality and privacy may prevent men from attending a healthcare facility to confirm their test results. Therefore, interventions that can influence men's social networks' norms towards HST and offer them an alternative location to confirm their test results may improve men's willingness to self-test and seek confirmatory testing for HIV. The proposed study will build on an ongoing trial (R01 MH098690-01) among networks of men in Tanzania. The Specific Aims are to: 1) examine the relationship between social network characteristics and willingness to self-test and confirm HIV test results at home versus a healthcare facility; 2) develop an unsupervised HST and confirmatory HIV testing intervention; 3) pilot and refine the intervention and; 4) assess the acceptability and feasibility of a 18-month unsupervised HST and confirmatory HIV testing at home or a healthcare facility-based intervention. Mentorship: A team of multidisciplinary experts, including Drs. Suzanne Maman, Charlotte Gaydos, Michael Sweat, Robert Faris, and Harsha Thirumurty will mentor me in the K99 phase to help me transition to becoming an independent investigator.