Study objective: We investigated two peer distribution models of HIV self-testing (HIVST) in HIV prevention demand creation compared with trained young community members (peer navigators).
Methods: We used restricted randomisation to allocate 24 peer navigator pairs (clusters) in KwaZulu-Natal 1:1:1: (1) standard of care (SOC): peer navigators distributed clinic referrals, pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) information to 18–30 year olds. (2) peer navigator direct distribution (PND): Peer navigators distributed HIVST packs (SOC plus two OraQuick HIVST kits) (3) incentivised peer networks (IPN): peer navigators recruited young community members (seeds) to distribute up to five HIVST packs to 18–30 year olds within their social networks. Seeds received 20 Rand (US1.5)foreachrecipientwhodistributedfurtherpacks.TheprimaryoutcomewasPrEP/ARTlinkage,definedasscreeningforPrEP/ARTeligibilitywithin90daysofpackdistributionperpeernavigatormonth(pnm)ofoutreach,inwomenaged18–24(apriorityforHIVprevention).Investigatorsandstatisticianswereblindedtoallocation.Analysiswasintentiontotreat.Totalandunitcostswerecollectedprospectively.Results:BetweenMarchandDecember2019,4163packs(1098SOC,1480PND,1585IPN)weredistributedacross24clusters.During144pnm,27218–30 yearoldslinkedtoPrEP/ART(1.9/pnm).Linkageratesfor18–24−year−oldwomenwerelowerforIPN(n=26,0.54/pnm)thanPND(n=45,0.80/pnm;SOCn=49,0.85/pnm).Rateratioswere0.68(9536) c.f. SOC (US$64). Cost per person linked to PrEP/ART was cheaper in both peer navigator arms compared with IPN.
Discussion: HIVST did not increase demand for PrEP/ART. Incentivised social network distribution reached large numbers with HIVST but resulted in fewer linkages compared with PrEP/ART promotion by peer navigators