{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T02:59:52Z","timestamp":1780109992735,"version":"3.54.0"},"reference-count":32,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2020,6,26]],"date-time":"2020-06-26T00:00:00Z","timestamp":1593129600000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5R01MH111602"],"award-info":[{"award-number":["5R01MH111602"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Without significant increases in uptake of HIV testing among men, it will be difficult to reduce HIV incidence to disease elimination levels. Secondary distribution of HIV self\u2010tests by women to their male partners is a promising approach for increasing male testing that is being implemented in several countries. Here, we examine male partner and couples testing outcomes and sexual decision making associated with this approach in a cluster randomized trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We examined data from women at higher risk of HIV participating in the intervention arm of an ongoing pair\u2010matched cluster randomized trial in Kenya. HIV\u2010negative women \u226518\u00a0years who self\u2010reported \u22652 partners in the past month were eligible. Participants received self\u2010tests at enrolment and three\u2010monthly intervals. They were encouraged to offer tests to sexual partners with whom they anticipated condomless sex. At six months, we collected data on self\u2010test distribution, male partner and couples testing, and testing and sexual behaviour in the three most recent transactional sex encounters. We used descriptive analyses and generalized estimating equation models to understand how sexual behaviour was influenced by self\u2010test distribution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From January 2018 to April 2019, 921\/1057 (87%) participants completed six\u2010month follow\u2010up. Average age was 28\u00a0years, 65% were married, and 72% reported income through sex work. Participants received 7283 self\u2010tests over six months, a median of eight per participant. Participants offered a median three self\u2010tests to sexual partners. Of participants with a primary partner, 94% offered them a self\u2010test. Of these, 97% accepted the test. When accepted, couples testing was reported among 91% of participants. Among 1954 transactional sex encounters, 64% included an offer to self\u2010test. When offered self\u2010tests were accepted by 93% of partners, and 84% who accepted conducted couples testing. Compared to partners with an HIV\u2010negative result, condom use was higher when men had a reactive result (56.3% vs. 89.7%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01), were not offered a self\u2010test (56.3% vs. 62.0%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.02), or refused to self\u2010test (56.3% vs. 78.3, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Providing women with multiple self\u2010tests facilitated male partner and couples testing, and led to safer sexual behaviour. These findings suggest secondary distribution is a promising approach for reaching men and has HIV prevention potential.<\/jats:p><jats:p><jats:bold>Clinical Trial Number:<\/jats:bold> NCT03135067.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25515","type":"journal-article","created":{"date-parts":[[2020,6,27]],"date-time":"2020-06-27T09:12:46Z","timestamp":1593249166000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Male partner testing and sexual behaviour following provision of multiple HIV self\u2010tests to Kenyan women at higher risk of HIV infection in a cluster randomized trial"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1146-8154","authenticated-orcid":false,"given":"Sue","family":"Napierala","sequence":"first","affiliation":[{"name":"Women\u2019s Global Health Imperative RTI International San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth F","family":"Bair","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noora","family":"Marcus","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perez","family":"Ochwal","sequence":"additional","affiliation":[{"name":"Impact Research and Development Organization Kisumu Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Maman","sequence":"additional","affiliation":[{"name":"Department of Health Behavior Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kawango","family":"Agot","sequence":"additional","affiliation":[{"name":"Impact Research and Development Organization Kisumu Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsha","family":"Thirumurthy","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy Perelman School of Medicine University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,26]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Global AIDS update: communities at the center","author":"UNAIDS","year":"2019"},{"key":"e_1_2_9_3_1","volume-title":"Understanding fast\u2010track: accelerating action to end the AIDS epidemic by 2030","author":"UNAIDS","year":"2015"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61348-9"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000655"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2011.02767.x"},{"key":"e_1_2_9_7_1","unstructured":"StaveteigS WangS HeadS BradleyS NybroE.Demographic patterns of HIV testing uptake in sub\u2010Saharan Africa. 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