Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study

Abstract

ObjectivesHIV testing is the gateway to HIV prevention and care services. Female sex workers (FSW) may benefit from HIV self-testing (HIVST), which offers greater control and confidentiality than other approaches. However, FSW also have unique vulnerabilities, making it critical to understand their perspective of HIVST to best contextualise HIVST to their needs. This study explored feasibility and acceptability of providing oral fluid-based peer-led HIVST to FSW to inform tailored HIVST delivery approaches.DesignQualitative study.SettingMalawi.ParticipantsThirty-nine FSW who had obtained a HIVST kit and eight peer distributors.ResultsPeer distributors’ accounts suggested that peer-led HIVST is feasible. Overall, FSW spoke positively about peer-led HIVST and younger FSW preferred it to facility-based HIV testing. FSW highlighted both greater control of their testing experience and that HIVST could allow them to avoid discriminatory attitudes frequently experienced in public facilities. Some also felt that HIVST kits could enable them to establish the HIV status of their sexual partners, better informing their decisions about condomless sex. Despite overall acceptance of HIVST, a few expressed doubts in the procedure. Some FSW already aware of their HIV-positive status reported using HIVST. A few accounts suggested peer pressure to self-test predominantly from peer distributors.ConclusionsThis study enabled us to explore feasibility and acceptability of peer-led HIVST among FSW, as well as potential shortcomings of the HIV testing modality. Peer distributors are a welcome additional model. However, they should avoid distribution in actual venues. Programmes should ensure a range of testing options are available and expand peer’s representation. Study findings will be used to tailor the HIVST distribution model to ensure its enhanced uptake among key populations in general and FSW, specifically.

Preferences for oral-fluid-based or blood-based HIV self-testing and provider-delivered testing: an observational study among different populations in Zimbabwe

“…Human Immunodeficiency Virus (HIV) testing continues to be an essential entry point into HIV prevention, treatment, care and support services [ 1 – 3 ]. Despite initiatives to increase access to, and uptake of, HIV testing such as provider-initiated HIV testing and counselling [ 4 ], community-based approaches [ 5 ] and partner notification [ 6 ], HIV testing gaps remain, and in many settings important population groups including men [ 7 , 8 ] and key populations such as female sex workers [ 9 , 10 ] continue to be missed.…”

Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study

“…Of note, doubts over the accuracy of oral-fluid-based HIVST found in this and other studies [ 27 , 29 ], need to be appropriately addressed to enhance acceptability and uptake of this testing modality.…”

“…There are perceived advantages and disadvantages of either method. For example, OFBST is widely viewed as simple, painless, quick and less invasive [ 27 , 28 ], but characterised by lower sensitivity [ 12 , 24 ]. BBST is perceived as more accurate [ 27 ] and having a higher sensitivity [ 24 ], but more invasive and complex to perform [ 29 ].…”

“…For example, OFBST is widely viewed as simple, painless, quick and less invasive [ 27 , 28 ], but characterised by lower sensitivity [ 12 , 24 ]. BBST is perceived as more accurate [ 27 ] and having a higher sensitivity [ 24 ], but more invasive and complex to perform [ 29 ]. Despite the availability of several different (blood-based) products, some of which cost as low as $1.00, most HIVST implementation to date has been oral-fluid-based owing to the simple nature of the oral fluid-based HIVST kits, despite their higher minimum cost of $2.50.…”

Acceptability and feasibility of HIV self-testing in Southeast Asia: A scoping review

“…3 Concerning error rates, this review highlighted counseling as an integral part of HIVST, which aligns with previous studies. 3,20,25,45,[48][49][50] Tertiary students in sub-Saharan Africa have shown that their preferred pretest counseling was through instruction leaflets, 46 whereas in this review, it was conducted through a hotline and in an online assessment for older and younger MSM, respectively. 29 In another study in sub-Saharan Africa, the lack of physical consultations decreased the significance of HIVST.…”