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

Abstract

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.

“I take it and give it to my partners who will give it to their partners”: Secondary distribution of HIV self-tests by key populations in Côte d’Ivoire, Mali, and Senegal

“…Effective HIV secondary distribution to partners, peers, and other relatives was achieved by the majority of primary users. This result confirms the feasibility of secondary distribution by MSM, FSW, and PWUD [ 11 ]. The lower level of HIVST distribution to casual clients of FSW, who were merely “passing through”, compared to the level of distribution to regular non client partners was also noted in Uganda [ 7 ].…”

“…Although our study does not allow us to quantify the proportion of people who received an HIVST and did not use it, the literature on the subject suggests that they are few of them. In Uganda, 81% of FSW who were provided with HIVST kits reported using them [ 11 ]. In a pilot study in the same country, 95% of kits dispensed through secondary distribution were used by MSM [ 23 ].…”

“…The HIVST strategy has been more commonly employed in Eastern and Southern Africa, than in WCA. Studies have found that HIVST is accepted by MSM and FSW, who are able to use and interpret the oral HIVST results correctly [8][9][10][11][12]. It allows to reach more MSM and FSW first-time testers [13] and to provide care services [10].…”

“Test-To-PrEP”: Assessing Reach and Adoption of a New Approach to Increase HIV Testing and PrEP Knowledge Using HIV Self-Test Kit Distribution Through PrEP Clients' Social Networks

“…This study used the RE-AIM framework to evaluate the Reach and Adoption of Testto-PrEP kits through egocentric social networks. Although the acceptability and feasibility of HIV self-testing is widely documented, 6,[21][22][23] our results demonstrate the opportunity to provide HIV testing and PrEP information to persons who might be hesitant or unable to seek clinic-based or community-based testing. The program reached critical populations for HIV testing and PrEP information dissemination; 16.2% reported no previous HIV test, and 38.5% reported never having heard about PrEP for HIV prevention before receiving the Test-to-PrEP kit.…”