Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial
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Date
2022
Authors
Armstrong-Hough, Mari
Ggita, Joseph
Gupta, Amanda J.
Shelby, Tyler
Nangendo, Joanita
Okello Ayen, Daniel
Davis, J. L.
Katamba, Achilles
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Open
Abstract
HIV status awareness is important for
household contacts of patients with tuberculosis (TB).
Home HIV testing during TB contact investigation increases
HIV status awareness. Social interactions during home
visits may influence perceived stigma and uptake of HIV
testing. We designed an intervention to normalise and
facilitate uptake of home HIV testing with five components:
guided selection of first tester; prosocial invitation scripts;
opt-out
framing; optional sharing of decisions to test; and
masking of decisions not to test.
Methods and analysis We will evaluate the intervention
effect in a household-randomised
controlled trial. The
primary aim is to assess whether contacts offered HIV
testing using the norming strategy will accept HIV testing
more often than those offered testing using standard
strategies. Approximately 198 households will be enrolled
through three public health facilities in Kampala, Uganda.
Households will be randomised to receive the norming
or standard strategy and visited by a community health
worker (CHW) assigned to that strategy. Eligible contacts
≥15 years will be offered optional, free, home HIV testing.
The primary outcome, proportion of contacts accepting HIV
testing, will be assessed by CHWs and analysed using an
intention-to-
treat
approach. Secondary outcomes will be
changes in perceived HIV stigma, changes in perceived TB
stigma, effects of perceived HIV stigma on HIV test uptake,
effects of perceived TB stigma on HIV test uptake and
proportions of first-invited
contacts who accept HIV testing.
Results will inform new, scalable strategies for delivering
HIV testing.
Ethics and dissemination This study was approved by
the Yale Human Investigation Committee (2000024852),
Makerere University School of Public Health Institutional
Review Board (661) and Uganda National Council on
Science and Technology (HS2567). All participants,
including patients and their household contacts, will
provide verbal informed consent. Results will be submitted
to a peer-reviewed
journal and disseminated to national
stakeholders, including policy-makers
and representatives
of affected communities.
Description
Keywords
Norming intervention, HIV testing, Stigma, Household tuberculosis contact, Cluster-randomised trial
Citation
Armstrong-Hough M, Ggita J, Gupta AJ, et al. Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial. BMJ Open 2022;12:e061508. doi:10.1136/ bmjopen-2022-061508