Abstract
We assessed whether informing female sex workers about the availability of HIV self-testing at clinics in Kenya using text messages would increase HIV testing rates. We selected a sample of 2196 female sex workers registered in an electronic health record system who were irregular HIV testers and randomized them to be sent a text message announcing the availability of (1) HIV self-test kits sent three times (intervention), (2) general HIV testing sent three times (enhanced standard of care [SOC]), or (3) general HIV testing sent one time (traditional SOC). Participants in the intervention arm were significantly more likely to test for HIV during 2-month follow-up compared to those in the enhanced SOC (OR 1.9, p = 0.001). There was no difference in HIV testing between those in the enhanced SOC and the traditional SOC arms. Announcing the availability of HIV self-testing via text message increased HIV testing among this high-risk group.
Highlights
MethodsWorldwide, HIV prevalence among sex workers is estimated to be as much as 12 times that of the general population [1]
A number of studies have found that bringing HIV self-testing to potential users can increase HIV testing rates, including in studies in which pregnant women distributed self-test kits to their main partners in Kenya [4] and Uganda [5], studies in which peer educators provided self-test kits to female sex workers in Uganda [6] and Zambia [7], and a home-based HIV testing study in Zambia which found that offering a self-test in addition to the standard provider-administered blood-based HIV test increased testing rates from 55.1 to 60.4% [5]
We calculated sample size assuming the enhanced SOC would achieve 48% testing rate (38–48% were expected to test after a text reminder based on past records in the electronic health record system), and found that in order to detect a risk ratio (RR) of 1.2 at 80% power and 95% confidence level, we would need a sample of about 750 female sex workers in each study arm
Summary
MethodsWorldwide, HIV prevalence among sex workers is estimated to be as much as 12 times that of the general population [1]. In a randomized controlled trial in 2015 among 305 truck drivers in Kenya, those offered oral HIV self-testing as a choice in addition to the standard provider-administered blood-based test when visiting a clinic had 2.8 times higher odds of accepting HIV testing compared to that of those only offered the standard HIV test (p = 0.002) [8, 9] Allowing those in the intervention arm to access self-test kits from the clinics over 6-months follow-up had no impact on testing during that time (OR 1.0, p = 0.972) [8]. If this is the case, making HIV self-testing available through facilities such as clinics and pharmacies may fail to reach those who are not accessing healthcare services, which would likely limit the impact this new testing modality has on curbing the HIV epidemic
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