Abstract
Objectives:To assess the effect of two health system approaches to distribute HIV self-tests on the number of female sex workers’ client and nonclient sexual partners.Design:Cluster randomized controlled trial.Methods:Peer educators recruited 965 participants. Peer educator–participant groups were randomized 1 : 1 : 1 to one of three arms: delivery of HIV self-tests directly from a peer educator, free facility-based delivery of HIV self-tests in exchange for coupons, or referral to standard-of-care HIV testing. Participants in all three arms completed four peer educator intervention sessions, which included counseling and condom distribution. Participants were asked the average number of client partners they had per night at baseline, 1 and 4 months, and the number of nonclient partners they had in the past 12 months (at baseline) and in the past month (at 1 month and 4 months).Results:At 4 months, participants reported significantly fewer clients per night in the direct delivery arm (mean difference −0.78 clients, 95% CI −1.28 to −0.28, P = 0.002) and the coupon arm (−0.71, 95% CI −1.21 to −0.21, P = 0.005) compared with standard of care. Similarly, they reported fewer nonclient partners in the direct delivery arm (−3.19, 95% CI −5.18 to −1.21, P = 0.002) and in the coupon arm (−1.84, 95% CI −3.81 to 0.14, P = 0.07) arm compared with standard of care.Conclusion:Expansion of HIV self-testing may have positive behavioral effects enhancing other HIV prevention efforts among female sex workers in Zambia.Trial Registration:ClinicalTrials.gov NCT02827240.
Highlights
HIV self-testing is a promising strategy to improve HIV testing coverage among diverse populations globally [1,2]
Participants were a median of 25 years of age [interquartile range (IQR) 21–30] and participants had been engaging in sex work for a median of 5 years (IQR 3–10 years)
In this study of HIV self-testing among female sex workers (FSW) in Zambia, access to an HIV self-test led to a significant decrease in Standard of Care (N 1⁄4 320)
Summary
HIV self-testing is a promising strategy to improve HIV testing coverage among diverse populations globally [1,2]. We previously demonstrated that HIV self-testing among female sex workers (FSW) in Zambia did not lead to an increase in HIV testing coverage or status knowledge when compared with referral to existing HIV-testing services [9]. Access to HIV self-testing may increase sense of control, as the technology allows freedom of choice of when, where, and with whom to use the test [10]. Awareness of and experience with the HIV self-test itself may change perceptions of risk of HIV acquisition, which could lead to changes in sexual behaviors [11]. For FSW access to an HIV selftest may lead to changes in the price for a sex act. Given the potential for these effects, understanding how HIV self-testing influences sexual behaviors is important for the design of HIV selftesting interventions
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