Yale University

Interrupting HIV stigma in the household using home HIV testing offers in South Africa

Funder: National Institute of Mental Health
Project period: 09/16/2019 - 09/15/2020
Grant Type: Research

Abstract Text:

With widespread access to high-quality HIV treatment, awareness of HIV status remains an important barrier to control of HIV in sub-Saharan Africa, especially among key populations such as men and close contacts of TB patients. Household testing by lay health workers offers a proven approach for reaching such populations. However, rates of test acceptance remain unacceptably low among key populations. Stigma related to both HIV and TB contribute to low uptake, and may be reinforced by social interactions at the household level. Social and behavioral science research on individual decision-making in group contexts suggests that (1) optimizing the order of test invitations to establish testing as the normative choice, (2) framing testing as a prosocial behavior, and (3) offering a less invasive test will reduce perceived stigma and improve uptake of testing. We propose mixed-methods studies with household members of TB patients and lay health workers delivering routine household contact investigation for TB and HIV in collaboration with the Aurum Institute in South Africa. The overall objective is to develop a complex behavioral intervention to reduce stigma and promote HIV testing uptake among household members of TB patients and to evaluate its feasibility and acceptability. Our innovative strategy includes three components, 1) acceptance-optimized sequencing of test invitations, 2) prosocial messaging, and 3) oral HIV testing. In Aim 1, we will iteratively refine the novel test invitation strategy using serial qualitative data collection with health workers and household contacts, as well as before-and-after surveys of contacts using validated stigma scales selected for their utility for TB- and HIV-specific stigma at the household level. In Aim 2, we will pilot the intervention using a pre-post implementation design. A multi-disciplinary research team includes experts in case-finding for TB-HIV, social sciences, and implementation research from The Aurum Institute and Yale School of Public Health. The expected impact is to generate preliminary data on a novel approach to offering home testing that reduces perceived stigma associated with HIV testing in households undergoing contact investigation for TB, and on its effects on testing and linkage to and retention in care. These data will inform a future randomized study evaluating the clinical impact of these innovative stigma-reducing, test-promoting approaches to offering TB and HIV counseling and testing in household settings.