Evidence map›Paper›PMID 25038356›Full record

Trial reportJAMA

Effect of optional home initiation of HIV care following HIV self-testing on antiretroviral therapy initiation among adults in Malawi: a randomized clinical trial.

Peter MacPherson, David G Lalloo, Emily L Webb, Hendramoorthy Maheswaran, Augustine T Choko, Simon D Makombe, Anthony E Butterworth, Joep J van Oosterhout, Nicola Desmond, Deus Thindwa and 3 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01414413 (Home Assessment and Initiation of ART), which is not on this map. Cited by 129 papers, 19 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
129citing papers in PubMed, 19 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01414413 nacompletednot on this map

Home Assessment and Initiation of ART: a Cluster-randomised Trial in Blantyre, Malawi

TypeinterventionalSponsorLiverpool School of Tropical MedicineRan2012 to 2013Enrolled16,660ConditionsHIVArmsHome assessment and initiation of ART, Clinic-based ART assessment and initiation
3 · Its place in the literature

Who cites it

129 citing papers in PubMed, 19 syntheses or guidelines pooled it.

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  5. Acceptability and uptake of HIV self-testing in emergency care settings: A systematic review and meta-analysis.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022
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69 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Peter MacPhersonDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom2TB and HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
David G LallooDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.
Emily L WebbMRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Hendramoorthy MaheswaranTB and HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi4Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, United Kingdom.
Augustine T ChokoTB and HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Simon D MakombeHIV Department, Ministry of Health, Lilongwe, Malawi.
Anthony E ButterworthDepartment of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Joep J van OosterhoutDepartment of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi8Dignitas International, Zomba, Malawi.
Nicola DesmondDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom2TB and HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Deus ThindwaTB and HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Stephen Bertel SquireDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.
Richard J HayesMRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Elizabeth L CorbettTB and HIV Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi6Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Funding

Medical Research Council MR/K012126/1Wellcome Trust 089673Wellcome Trust 091769Wellcome Trust 097973Wellcome Trust 100714Wellcome Trust 100890
6 · The paper itself

Abstract

importanceSelf-testing for HIV infection may contribute to early diagnosis of HIV, but without necessarily increasing antiretroviral therapy (ART) initiation.

objectiveTo investigate whether offering optional home initiation of HIV care after HIV self-testing might increase demand for ART initiation, compared with HIV self-testing accompanied by facility-based services only. DESIGN, SETTING, AND

participantsCluster randomized trial conducted in Blantyre, Malawi, between January 30 and November 5, 2012, using restricted 1:1 randomization of 14 community health worker catchment areas. Participants were all adult (≥16 years) residents (n = 16,660) who received access to home HIV self-testing through resident volunteers. This was a second-stage randomization of clusters allocated to the HIV self-testing group of a parent trial.

interventionsClusters were randomly allocated to facility-based care or optional home initiation of HIV care (including 2 weeks of ART if eligible) for participants reporting positive HIV self-test results. MAIN OUTCOMES AND MEASURES: The preplanned primary outcome compared between groups the proportion of all adult residents who initiated ART within the first 6 months of HIV self-testing availability. Secondary outcomes were uptake of HIV self-testing, reporting of positive HIV self-test results, and rates of loss from ART at 6 months.

resultsA significantly greater proportion of adults in the home group initiated ART (181/8194, 2.2%) compared with the facility group (63/8466, 0.7%; risk ratio [RR], 2.94, 95% CI, 2.10-4.12; P < .001). Uptake of HIV self-testing was high in both the home (5287/8194, 64.9%) and facility groups (4433/8466, 52.7%; RR, 1.23; 95% CI, 0.96-1.58; P = .10). Significantly more adults reported positive HIV self-test results in the home group (490/8194 [6.0%] vs the facility group, 278/8466 [3.3%]; RR, 1.86; 95% CI, 1.16-2.97; P = .006). After 6 months, 52 of 181 ART initiators (28.7%) and 15 of 63 ART initiators (23.8%) in the home and facility groups, respectively, were lost from ART (adjusted incidence rate ratio, 1.18; 95% CI, 0.62-2.25, P = .57). CONCLUSIONS AND RELEVANCE: Among Malawian adults offered HIV self-testing, optional home initiation of care compared with standard HIV care resulted in a significant increase in the proportion of adults initiating ART.

trial registrationclinicaltrials.gov Identifier: NCT01414413.

Indexed as

Home Care ServicesAdolescentAdultAnti-Retroviral AgentsFemaleHIV InfectionsHIV SeropositivityHumansMalawiMaleMass ScreeningMiddle AgedPatient ComplianceSelf CareYoung AdultAnti-Retroviral Agents

Identifiers

PMID25038356
PMCPMC4118051

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.