Reaching the Last 20% (the Pamoja Kwa Afya Study)

HIV testing

This cluster randomized controlled trial will test whether the provision of multiple oral
 fluid-based HIV self-test kits to women who sell sex (WSS) to secondarily distribute to their
 male partners who purchase sex can promote uptake of HIV service use by male partners. The
 study will recruit adult women who report exchanging sex for compensation in Kisumu and Siaya
 counties in Western Kenya. In clusters randomized to the intervention, WSS will be given
 multiple HIV self-tests and counseled to distribute them to men who purchase sex (MPS).
 Self-test kits will contain instructions for use and tailored information on clinic location
 and hours within the cluster, and pilot-tested messaging on the benefits of antiretroviral
 therapy (ART) and pre-exposure prophylaxis (PrEP). In control clusters, standard of care HIV
 services will continue to be available. To objectively assess impacts of the intervention on
 post-HIVST linkage outcomes, the investigators will monitor use of HIV services by men at HIV
 clinics in both study arms on a monthly basis. Our goal will be to determine whether
 confirmatory testing (primary outcome), case diagnoses, ART initiation, and PrEP initiation
 by men in intervention clusters are higher than in control clusters. Mixed methods research
 will be utilized to conduct a process evaluation to assess mechanisms that may have impacted
 intervention effectiveness, pathways for linkage among MPS, and support for men's linkage to
 HIV services under a secondary distribution model. Cost-effectiveness analyses will also be
 undertaken.