Peer delivered HIV/syphilis self-testing with assisted partner notification services for men who have sex with men (MSM) in Uganda

PROJECT SUMMARY/ABSTRACT The overall goal of the proposed K43 Emerging Global Leader Award is to support Dr. Stephen Okoboi’s research training to develop as an independent global health HIV researcher. Dr. Okoboi is currently a postdoctoral fellow and Deputy Head of Research at Makerere University Infectious Disease Institute in Uganda. Conducting the proposed studies in this application will facilitate his training goals to: 1) gain expertise in behavioural science methods to better understand the processes and preventive behaviours underlying peer delivery of HIV and syphilis self-tests combined with assisted partner notification (APN) services, 2) gain expertise in the design and conduct of randomized trials in real world settings, and 3) acquire advanced skills in health economic evaluation. This proposal builds on the unique skills he already has in epidemiology and nursing while leveraging a multidisciplinary team of mentors to ultimately become a productive and influential independent investigator in HIV prevention research. The research goal of this proposal is to conduct a rigorous proof-of-concept evaluation to assess the feasibility, acceptability, preliminary effectiveness, and cost effectiveness of peer delivered HIV and syphilis self-testing coupled with assisted partner notification services. Men who engage in sexual relations with other men (MSM) are disproportionately affected by HIV and syphilis. In Uganda, MSM HIV prevalence is 13.2% versus 4.7% in similarly aged males, while syphilis prevalence is 8.3% versus 5.8% in males aged 15-64 years. Syphilis and HIV transmission share common transmission routes and syphilis increases risk of HIV acquisition, transmission, and disease progression. The World Health Organization recommends dual HIV/syphilis testing for MSM, but uptake of facility-based testing is low because of stigma and discrimination in healthcare settings. Differentiated service delivery models, such as peer delivered HIV/syphilis self-tests and linkage to care for those who test positive, could circumvent health facility stigma and other structural barriers to accessing care. However, no studies to our knowledge have evaluated the effectiveness of peer delivered HIV/syphilis self-testing linked to partner services for MSM. To address this research gap, Dr. Okoboi will conduct formative research to inform the implementation of peer-delivered HIV/syphilis self-tests combined with APN for Ugandan MSM (Aim 1), conduct a randomized trial to pilot test the preliminary effectiveness of peer delivered HIV/syphilis self-tests and APN relative to standard of care (Aim 2), and estimate the cost implications of peer-delivered HIV/syphilis self-testing and APN compared to facility-based testing (Aim 3). Dr. Okoboi’ s research goals correspond with his training goals, and at the completion of this award, he will be in an excellent position to submit an R01 application to further advance HIV prevention research for MSM in sub-Saharan Africa.