ASSESSMENT OF POSSIBLE OUTLETS
FOR DISTRIBUTION OF HIV ORAL
SELF-TEST KITS IN KENYA
J. Okal1, F. Obare2, J. Matheka1, W. Tun3
1Population
Council, HIV, Nairobi, Kenya, 2Population Council,
Reproductive Health, Nairobi, Kenya, 3Population Council, HIV,
Washington, United States
20th International AIDS Society Conference
Melbourne, Australia (20–25 July 2014)
Background
• Marked increase in HIV testing and counseling (HTC)
levels from 34% 2007 to 72%
– Only 47% of HIV-positive individuals know their status
– Confidentiality concerns remain a barrier to facility-based
HTC
• Rapid tests provide opportunity to overcome
confidentiality and convenience barriers
• Use of HIV oral self-test kits already considered by
Kenya government
– Limited understanding of how well to distribute the kits
Study objectives
• Overall objective:
– Generate evidence to inform the design and evaluation of
programs using HIV oral self-tests in Kenya
• Specific objectives are:
– Examine the possible outlets and/or networks for the
distribution of HIV oral self-tests to potential users in Kenya
– Explore how the distribution of HIV oral self-tests through various
channels can be organized to better meet the needs of potential
users
– Examine the possible linkages to counseling and care for users
of HIV oral self-tests given the choice of the distribution outlet
METHODS
Study design
• Cross-sectional exploratory design involving quantitative and
qualitative data collection
• 3 components involving demonstration of use of the kits
– Community survey
– Service provider interviews
– Key informant interviews (KIIs)
• Random and purposive selection of samples based on
component
– Community survey—random selection of samples
– Service provider interviews
• Random selection of facility-based providers
• Purposive selection of community-based providers
– KIIs—purposive selection of informants
Data collection: Community survey
• Mid to end October 2013
– 1,436 adults, 18–64 years
(969 women, 467 men)
– 4 counties—Kisumu, Uasin
Gishu, Nyandarua and Kilifi
– Information collected
•
•
•
•
Background characteristics
Potential use of the kits
Preferred distribution outlet
Linkage to counselling and care
Data collection: Service provider
interviews
• Mid to end October 2013
– 317 service providers aged 20–65 years
•
•
•
•
Public and private for- and not-for profit health facilities
Stand-alone voluntary counselling and testing (VCT) centres
Private pharmacies
Community health workers (CHWs), traditional birth attendants (TBAs) and
shop/supermarket owners
– 5 counties—Kisumu, Uasin Gishu, Nairobi, Nyandarua, Kilifi
– Information collected
•
•
•
•
•
•
Background characteristics
Services provided at outlet
Potential use of HIV oral self-test kits by clients
Possible channels for distributing the kits
Readiness to give information and/or distribute the kits
Linkage to counselling and care
Data collection: KIIs
• Mid to end October 2013
– 27 key informants
•
•
•
•
•
•
Opinion leaders (chiefs and assistant chiefs)
Representatives of community-based organisations (CBOs)
Ministry of Health—DASCOs, PASCOs, NASCOP
KEMSA
Social marketing and outreach agencies
Special groups (Key populations, FSWs, PWID, PWDs)
– 5 counties—Kisumu, Uasin Gishu, Nairobi, Nyandarua, Kilifi
– Information collected
•
•
•
•
Potential use of the kits in the community
Readiness to give information and/or distribute the kits
How the distribution channel can be organized to meet clients’ needs
Linkage to counselling and care
RESULTS
Prior testing for HIV
Stand-alone VCT center
1.1
1.6
Home
3.5
3.8
Faith-based/NGO facility
7.5
6.5
Private health facility
8.3
7.5
27.2
16.1
Mobile clinic/outreach
52.4
64.6
Public health facility
0
Men
• 93% of survey women
and 79% of survey men
had previously tested for
HIV
20
40
Women
60
80
• Among those previously
tested, 65% of women
and 52% of men had last
test in a public health
facility
Potential use of HIV oral self-test kits
• Majority of survey respondents indicated that they would use the
kits (94% of women and men)
• 91% of service providers also reported that their clients would
use the kits
• KIIs also showed that many people would use the kits
People want to know their status but the problem with the current HTC
set up is that for me to know [my status] someone have to know [my
status].
—NGO sector informant
People will know their status, and through test that fear of sharing your
status in public will be eliminated.
—Service delivery organization
Possible distribution channels
• 83% of survey respondents mentioned public health
facility as either the main or alternative source of HIV oral
self-test kits
• 24% of the respondents mentioned private pharmacy
• Other the main or alternative sources of HIV oral self-test
kits included local administration (20% of the women and
27% of the men), private health facilities (24% of the
women and 18% of the men), and local shops or
supermarkets
Possible distribution channels (cont’d)
FBO/NGO facility
CHW
Mobile clinic
Shop/supermarket
Private facility
Local administration
Private pharmacy
Public facility
9.8
10.0
9.7
10.1
9.8
10.2
13.0
11.1
14.0
17.8
20.0
16.7
21.6
17.7
23.5
22.1
26.5
19.9
23.9
21.5
25.0
Both sexes
Men
Women
82.8
80.5
83.9
Possible distribution channels (cont’d)
• Advantages of public health facilities noted among survey
respondents, service providers and key informants
– Widely spread thereby allowing for ease of access (distance)
– Cost of services affordable
– Quality of services—availability and interactions with clients
• Limitations of public health facilities mentioned by service
providers and key informants
–
–
–
–
–
Red tape and bureaucracy
Lack of privacy and confidentiality
Inadequate staff
Lack of training
Long waiting time
Readiness to provide information and
distribute kits
• 97% of providers would give information while 93% would
distribute the kits
• Reasons for readiness to provide information:
–
–
–
–
Adequate human resources (52%)
Adequate infrastructure (35%)
Large clientele (34%)
Appropriate training (28%)
• Major reasons for readiness to distribute kits:
–
–
–
–
Providers had large clientele (59%)
Distribution does not require huge amounts of resources (26%)
Adequate human resources (25%)
Adequate infrastructure (24%)
Readiness to provide information and
distribute kits (cont’d)
• Readiness to give information and/or distribute kits also
evident from key informants
I don’t foresee a challenge so long as everything has been worked
out. As long as we have clear guidelines on, ‘after you test this is
what will happen’, test kits are located here, this is the person
mandated to give out the test kits, how do we do the returns—
accountability, because right now if we have free test kits for which
we are not charging the patients, there is bound to be some
pilferage or something. Yeah, so long as all that is clear before we
start, then I don’t foresee challenges.
—Public health manager
Organization of distribution channels
• Support needed to provide information:
–
–
–
–
–
Training or updates on self-test (71%)
Adequate IEC materials (64%)
Community sensitization (52%)
Additional financial resources (47%)
Additional human resources (33%)
• Support needed to distribute:
–
–
–
–
Training or updates on self-test (54%)
Reliable supplies (52%)
Community sensitization (51%)
Adequate IEC materials and additional financial resources
(47% each)
Linkage to counseling and care
• >70% of women and men indicated they would seek
counseling services before/after performing HIV self-test
• 62% and 71% of providers felt that clients would seek
counseling services before and after performing HIV oral
self-test respectively
• Key informants had mixed views
It will depend if I get I am negative, I will not need, there are those
who will need it if they are positive, but also the other dimension
was that if I take this kit two or three times in my house and find
that am positive, naturally I will want to go to the hospital.
—Key populations provider
Source of counseling services
• Public health facilities were the most preferred sources of
counseling services before or after testing among survey
women and men
• 75% of women and 71% of men who would seek counseling
services before testing mentioned “public health facility” as
the most convenient place to go for the services
• 79% of women and 76% of men who would seek counseling
services after testing mentioned public health facility as the
place where they would go for the services
SUMMARY OF
FINDINGS/IMPLICATIONS
Summary of findings
• Near-universal acceptance of the use of HIV oral self-test
kits among survey respondents
– Service providers and key informants further confirmed that the
test kits would be acceptable in the community
• Public health facilities were the most commonly mentioned
outlets where clients would seek counseling and other
services before or after performing HIV self-test
• Efficient organization of the distribution channel requires
–
–
–
–
Training and/or updates on self-test
Adequate IEC materials
Community sensitization
Reliable supplies of the test kits
Thank You
• International Initiative for Impact Evaluation (3ie)
• MoH/NASCOP
• Stakeholders who participated
• Respondents who shared information
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