Acceptability of oral HIV self-testing among female sex workers in Gaborone, Botswana

Shava, Emily; Manyake, Kutlo; Mdluli, Charlotte; Maribe, Kamogelo; Monnapula, Neo; Nkomo, Bornapate; Mosepele, Mosepele; Moyo, Sikhulile; Mmalane, Mompati; Bärnighausen, Till; Makhema, Joseph; Bogart, Laura M.; Lockman, Shahin

doi:10.1371/journal.pone.0236052

Cited by 25 publications

(48 citation statements)

References 36 publications

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“…Selecting the appropriate mode of kit distribution was important to ensure accessibility and adoption [57,78,90,92,99,104,105,108,110,112,119,122,137,139,141,163,184,189,190,202,204]. Modes of distribution described include: (1) direct delivery by community health workers, peers, partners, and sex workers, (2) Home delivery, and (3) Pick up at health facilities or community-based organizations or other sites (e.g., health clubs, markets, private pharmacies, vending machines).…”

Section: Positive Perceptions On Hiv-stmentioning

confidence: 99%

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

et al. 2021

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Introduction HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. Methods We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. Results and discussion Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. Conclusions Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.

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Section: Positive Perceptions On Hiv-stmentioning

confidence: 99%

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

et al. 2021

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“…Some studies have also concluded that FSW may require some form of training in order for then to correctly perform unassisted HIV self-testing [ 37 ]. In Botswana, we previously conducted a qualitative study among FSW in Gaborone to explore the acceptability of HIV self-testing and of secondary distribution of HIV self-test kits [ 38 ]. The qualitative study showed that, despite having no prior knowledge of HIV self-testing, female sex workers in Gaborone perceived it to be a highly acceptable method of HIV testing.…”

Section: Introductionmentioning

confidence: 99%

“…The research signaled the need for addressing identified structural barriers in the healthcare system in the implementation of HIV self-testing. It further highlighted the importance of having a FSW peer-driven approach when implementing self-testing in this key population, with some oversight and guidance from healthcare professionals [ 38 ]. The actual uptake of HIV self-testing has not been evaluated in FSW in Botswana, who are at increased risk for HIV [ 39 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of oral HIV self-testing in female sex workers in Gaborone, Botswana

et al. 2021

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Background Oral HIV self-testing (HIVST) may be useful for increasing testing in persons at elevated risk of acquiring HIV. Methods We conducted a pilot study to evaluate the feasibility (defined by uptake) of HIVST among FSW in Gaborone, Botswana. FSW age 18 years and above were recruited through a non-governmental organization serving FSW. FSW with unknown or negative HIV status at screening performed HIVST in the study clinic following brief training. FSW testing HIV-negative were each given two test kits to take home: one kit to perform unassisted HIVST and another to share with others. Feasibility (use) of HIVST (and sharing of test kits with others) was assessed in these women at a study visit four months later. Results Two hundred FSW were screened. Their average age was 34 years (range 18–59), and 115 (58%) were HIV-positive. Eighty-five (42%) tested HIV-negative at entry and were eligible to take part in the HIVST pilot study. All 85 (100%) agreed to take home HIVST kits. Sixty-nine (81%) of these 85 participants had a follow-up visit, 56 (81%) of whom reported performing HIVST at a mean of three and half months after the initial visit. All 56 participants who performed HIVST reported negative HIVST results. Fifty (73%) of the 69 participants who took HIVST kits home shared them with others. Of the 50 women sharing HIVST kits, 25 (50%) shared with their non-client partners, 15 with a family member, 8 with friends, and 3 with a client. One participant did not test herself but shared both her test kits. Most participants 53/56 (95%) found oral HIVST very easy to use whilst 3/56 (5%) felt it was fairly easy. Conclusion Oral HIVST is feasible among FSW in Gaborone, Botswana. The majority of FSW used the HIVST kits themselves and also shared extra HIVST kits with other individuals.

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“…Although the acceptability of HIVST, which includes both oral fluid test (OFT) and blood-based kits, has been studied among key populations, the studies are overwhelmingly performed among MSM in high-income countries and with varied types of supervisions [ 17 - 22 ]. However, the studies performed among FSWs demonstrated HIVST as a highly accepted strategy [ 21 , 23 - 26 ], which is a promising alternative to facility-based HIV testing.…”

Section: Introductionmentioning

confidence: 99%

Web-Based Multifaceted Approach for Community-Based HIV Self-Testing Among Female Sex Workers in Indonesia: Protocol for a Randomized Community Trial

Yunus¹,

Sawitri²,

Wirawan³

et al. 2021

JMIR Res Protoc

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Background New HIV infections in Indonesia continue to be concentrated among key populations, including female sex workers (FSWs). However, increasing HIV testing among this subpopulation remains a challenge, necessitating exploration into alternative testing modalities. Objective This study aims to assess whether the addition of an oral fluid testing option in community settings would increase the rate of HIV case identification among FSWs. Because the study was implemented early in the outbreak of COVID-19 in Indonesia, a secondary objective is to assess approaches and tools for implementing both community outreach and community HIV screening for FSWs during pandemic conditions. Methods We undertook a community-based randomized trial in 23 national priority districts in which community outreach services were being provided. Community-based screening using an oral fluid-based rapid test was added to the community outreach standard of care in intervention districts with clients having the option of performing the test themselves or being assisted by outreach workers. A web-based system was created to screen for eligibility and collect participant data and test results, facilitating the process for both unassisted and assisted participants. Participants with reactive screening results were encouraged to undergo HIV testing at a health facility to confirm their diagnosis and initiate antiretroviral treatment as needed. Multiple means of recruitment were deployed including through outreach workers and social media campaigns. Results Of the 1907 FSWs who registered, met the eligibility criteria, and gave consent to participate, 1545 undertook community oral fluid test (OFT) screening. Most (1516/1545, 98.1%) opted for assisted screening. Recruitment via social media fell far short of expectations as many who registered independently for the OFT because of the social media campaign did not identify as FSWs. They were eventually not eligible to participate, but their interest points to the possibility of implementing HIV self-testing in the general population. The successful recruitment through outreach workers, facilitated by social media, indicates that their roles remain crucial in accessing FSW networks and improving HIV testing uptake. Conclusions The addition of HIV self-testing to the standard of care supported by a web-based data collection system was able to increase HIV case identification among FSWs in intervention districts. The high satisfaction of OFT users and the interest of the general population toward this alternative testing modality are promising for scaling up community HIV screening nationally. Trial Registration ClinicalTrials.gov NCT04578145; https://clinicaltrials.gov/ct2/show/NCT04578145 International Registered Report Identifier (IRRID) RR1-10.2196/27168

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Acceptability of oral HIV self-testing among female sex workers in Gaborone, Botswana

Abstract: Background HIV prevalence among female sex workers (FSW) in sub-Saharan Africa is much higher than in the general population. HIV self-testing (HIVST) may be useful for increasing testing rates in FSW.

Cited by 25 publications

References 36 publications

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review

Feasibility of oral HIV self-testing in female sex workers in Gaborone, Botswana

Web-Based Multifaceted Approach for Community-Based HIV Self-Testing Among Female Sex Workers in Indonesia: Protocol for a Randomized Community Trial

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