Date Published: August 21, 2018
Publisher: Taylor & Francis
Author(s): Elizabeth A. Kelvin, Gavin George, Eva Mwai, Eston Nyaga, Joanne E. Mantell, Matthew L. Romo, Jacob O. Odhiambo, Lila Starbuck, Kaymarlin Govender.
We conducted a randomized controlled trial among 305 truck drivers from two North Star Alliance roadside wellness clinics in Kenya to see if offering HIV testing choices would increase HIV testing uptake. Participants were randomized to be offered (1) a provider-administered rapid blood (finger-prick) HIV test (i.e., standard of care [SOC]) or (2) a Choice between SOC or a self-administered oral rapid HIV test with provider supervision in the clinic. Participants in the Choice arm who refused HIV testing in the clinic were offered a test kit for home use with phone-based posttest counseling. We compared HIV test uptake using the Mantel Haenszel odds ratio (OR) adjusting for clinic.
Truck drivers in sub-Saharan Africa are at high risk for HIV (Ojo et al., 2011). This may be, in part, because mobility forces couples to be apart, leading to the use of commercial sex services which cluster around transportation routes (International Labor Organization, 2005; Lafort et al., 2010; Regondi, George, & Pillay, 2013). A 1991 study among truck drivers in Kenya reported that 61% visited female sex workers (FSWs), only 32% had ever used condoms (Bwayo et al., 1991), and 18% tested HIV+ (Bwayo et al., 1991). Another study in Kenya 1993–1997 found that HIV incidence among truck drivers was significantly higher than among stationary staff at the same company (i.e., administrators, mechanics) (Rakwar et al., 1999), and a 2003–2004 survey of 1896 long-distance truck drivers in South Africa found 26% HIV prevalence, with a dose-response relationship with time on the road (Delany-Moretlwe et al., 2014). Other studies among truck drivers in Africa also found high HIV prevalence (Azuonwu, Erhabor, & Frank-Peterside, 2011; Frank et al., 2013; Ramjee & Gouws, 2002). While few studies have looked at HIV testing among truck drivers, the South Africa study found that only 38.2% had ever tested for HIV (Delany-Moretlwe et al., 2014), and a 2009 study in a clinic at a truck stop in Mozambique found that only 25% of participants accepted HIV testing when offered and, and of those, 27% tested HIV+ (Lafort et al., 2010).
To our knowledge, this is the first study to look at offering self-administered oral HIV testing to truck drivers, and one of the first to compare the offer of HIV testing choices versus a single option in any population. We found that truck drivers offered a choice of HIV testing methods were more likely to test compared to those offered only the SOC test. This difference did not reach statistical significance when only looking at testing in the clinic (OR = 1.5, p = 0.189), but it was significant when including taking a test kit for use at home (OR = 2.8, p = 0.002). Importantly, the additional 11 people who tested at home had already refused both in-clinic HIV testing options and would not have tested at all if they had not been offered a test kit to take with them. The higher uptake of self-administered testing in the clinic (64.6%) and for use outside of the clinic (8.5%) compared to the SOC test (chosen by 26.9%) among those offered a choice suggests that truck drivers in Kenya are ready for self-testing, as has also been indicated by studies with other groups in Kenya (Heard & Brown, 2016).