Innovative Tools to Expand HIV Self-Testing and Long-Acting Injectables for HIV Treatment and Prevention Among Commercial Minibus Drivers (I-TEST LAIs)

Abstract: Commercial minibus drivers constitute a large social network of highly mobile men who work long and demanding hours, are at increased risk for HIV, and have limited time to seek health services for HIV. In our preliminary work, our team found a high HIV seropositivity rate of 12.5% among 407 commercial minibus drivers in Nigeria, a prevalence that is nine times

higher than the national HIV average. Despite the high willingness to test for HIV among the drivers, the mobile nature of their work poses substantial barriers for those living with HIV to initiate and adhere to antiretroviral therapy (ART) and for those who are HIV-negative and are at risk for HIV to obtain pre-exposure prophylaxis (PrEP). Therefore, innovative strategies such as

HIV self-testing (HIVST), which allows individuals to test at home or in private, and long-acting- injectable ART (LAI ART) or LAI PrEP may work better to address the barriers that impede commercial drivers from accessing HIV testing, prevention, and treatment services. Our team has recently evaluated a youth-friendly HIVST intervention combined with linkage to PrEP in

Nigeria as part of an NIH-funded project called ITEST: Innovative Tools to Expand Youth- friendly HIV Self-Testing (UH3HD096929). We propose to leverage our established research program in Nigeria in collaboration with the National Institute of Medical Research to implement a tailored ITEST intervention for commercial minibus drivers (ITEST LAIs), which will include

male peer-led distribution of HIV self-testing kits combined with demand creation for both oral and LAI modalities of ART and PrEP. Our multi-disciplinary research team proposes a hybrid type I effectiveness-implementation study to assess clinical and implementation determinants outcomes simultaneously. Our specific aims are: Aim 1: Determine the comparative

effectiveness of the I-TEST LAI intervention compared to SoC on LAI PrEP uptake and HIV prevention among minibus drivers in Nigeria. In addition, explore the impact of mediating and moderating factors on influencing primary and secondary outcomes. Aim 2: D etermine the effectiveness of the I-TEST LAI intervention compared to SoC on LAI ART uptake, retention in

care, and viral suppression among minibus drivers living with HIV with viral suppression (VL below 1000 HIV RNA copies/ml). In addition, explore the impact of mediating and moderating factors on influencing primary and secondary outcomes. Aim 3: As part of our type 1 hybrid implementation-effectiveness design, assess determinants of implementation, and estimate

cost-effectiveness to inform scale-up and dissemination.