Acceptability of HIV self-testing to support pre-exposure prophylaxis among female sex workers in Uganda and Zambia: results from two randomized controlled trials

Katrina F Ortblad,Catherine E Oldenburg,Steven Chongo,Till Bärnighausen,Magdalene Mwale,Daniel Kibuuka Musoke,Aidah Nakitende,Nyambe Kamungoma,Michael M Chanda,Thomson Ngabirano,Catherine Kanchele

doi:10.1186/s12879-018-3415-z

Abstract

BackgroundHIV pre-exposure prophylaxis (PrEP) is highly effective for prevention of HIV acquisition, but requires HIV testing at regular intervals. Female sex workers (FSWs) are a priority population for HIV prevention interventions in many settings, but face barriers to accessing healthcare. Here, we assessed the acceptability of HIV self-testing for regular HIV testing during PrEP implementation among FSWs participating in a randomized controlled trial of HIV self-testing delivery models.MethodsWe used data from two HIV self-testing randomized controlled trials with identical protocols in Zambia and in Uganda. From September–October 2016, participants were randomized in groups to: (1) direct delivery of an HIV self-test, (2) delivery of a coupon, exchangeable for an HIV self-test at nearby health clinics, or (3) standard HIV testing services. Participants completed assessments at baseline and 4 weeks. Participants reporting their last HIV test was negative were asked about their interest in various PrEP modalities and their HIV testing preferences. We used mixed effects logistic regression models to measure differences in outcomes across randomization arms at four weeks.ResultsAt 4 weeks, 633 participants in Zambia and 749 participants in Uganda reported testing negative at their last HIV test. The majority of participants in both studies were “very interested” in daily oral PrEP (91% Zambia; 66% Uganda) and preferred HIV self-testing to standard testing services while on PrEP (87% Zambia; 82% Uganda). Participants in the HIV self-testing intervention arms more often reported preference for HIV self-testing compared to standard testing services to support PrEP in both Zambia (P = 0.002) and Uganda (P < 0.001).ConclusionPrEP implementation programs for FSW could consider inclusion of HIV self-testing to reduce the clinic-based HIV testing burden.Trial registrationClinicalTrials.gov NCT02827240 and NCT02846402.

Highlights

HIV pre-exposure prophylaxis (PrEP) is highly effective for prevention of HIV acquisition, but requires HIV testing at regular intervals
From September–October of 2016, 965 participants enrolled in the Zambia trial and 960 participants enrolled in the Uganda trial (Fig. 1)
Acceptability of PrEP for prevention of HIV acquisition was high among Female sex workers (FSWs) in both Zambia and Uganda, but some PrEP modalities were more popular than others

Summary

Introduction

HIV pre-exposure prophylaxis (PrEP) is highly effective for prevention of HIV acquisition, but requires HIV testing at regular intervals. We assessed the acceptability of HIV self-testing for regular HIV testing during PrEP implementation among FSWs participating in a randomized controlled trial of HIV self-testing delivery models. HIV pre-exposure prophylaxis (PrEP) is highly efficacious for the prevention of HIV acquisition in men who have sex with men [1] and heterosexual serodiscordant couples [2, 3]. HIV self-testing allows individuals to test for HIV at the time and place of their choosing, and may reduce some barriers to accessing regular HIV testing. In the context of PrEP implementation programs, HIV self-testing might be a useful complement to clinic-based testing [11]. HIV self-testing has generally been shown to be acceptable [13, 14] and has been implemented in diverse populations of users [15]

Methods

Results

Discussion

Conclusion