Formative assessment to identify perceived benefits and barriers of HIV oral self-testing among female sex workers, service providers, outreach workers, and peer educators to inform scale-up in Kenya

Agot, Kawango; Cain, Meagan; Medley, Amy; Kimani, Joshua; Gichangi, Peter; Kiio, Caroline; Mukiri, Elosy; Odonde, Petronila; Toroitich‐Ruto, Cathy; Bingham, Trista; Downer, Marie; Chesang, Kipruto

doi:10.1080/09540121.2021.1894318

Cited by 5 publications

(16 citation statements)

References 24 publications

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“…All the study participants showed interest in using HIVST if made available in Benin. This nding is compatible with the results of several studies conducted in different contexts which show high acceptability of HIVST in key populations 1,13,15,22,23,24,25,26,27,28,29,30,31,32,33,34 . HIVST seemed to be particularly attracting for the participants because it promotes autonomy and privacy.…”

Section: Discussionsupporting

confidence: 92%

HIV Self-Testing Implementation, Distribution and Use Among Female Sex Workers in Cotonou, Benin: A Qualitative Evaluation of Acceptability and Feasibility

Moreau¹,

Kintin²,

Atchekpe³

et al. 2021

Preprint

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Background In Benin, the burden of HIV is disproportionately high among female sex workers (FSWs). HIV testing and knowledge of status are starting points for HIV treatment and prevention interventions. Despite the importance given to testing services in HIV control, its uptake among FSWs remains suboptimal in Benin. HIV self-testing (HIVST) may be useful for increasing testing rates in FSWs. Methods We conducted a pilot study of the distribution of saliva-based HIVST among FSWs in Cotonou and its surroundings, Benin. The HIVST promotion and distribution model included three complementary strategies: community-based, facility-based and secondary distribution. In this qualitative study, we explored the elements influencing HIVST implementation, distribution and use among FSWs. We assessed HIVST acceptability and feasibility in this population. We conducted 29 semi-structured individual interviews with FSWs. Data were interpreted with a thematic analysis method, using the Theoretical Domains Framework. Results Only two FSWs (6.9%) were aware of HIVST before participating in the study. All participants were interested in using HIVST if available in Benin. Many advantages of HIVST were mentioned, including: autonomy, privacy, accessibility, time saving, and the fact that it is a painless test. Barriers to the use of HIVST included: the fear of unreliability, the lack of psychological support and medical follow-up and the possibility of result dissimulation. Participants thought HIVST was easy to use without assistance. HIVST enabled linkage to care for a few FSWs in denial of their HIV-positive status. No case of suicide or violence associated with HIVST was reported. HIVST secondary distribution within FSWs social network was well received. FSWs’ boyfriends and clients showed interest in using the device. Some FSWs reported using HIVST to practice serosorting or to guide their decisions regarding condom use. Conclusions Our study shows a very high level of acceptability for HIVST among FSWs in Cotonou and its surroundings. Results also demonstrate the feasibility of implementing HIVST distribution in Benin. HIVST should be implemented in Benin quickly and free of charge for all individuals at risk of HIV. HIVST offer should be integrated with comprehensive sexual health and prevention services.

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Section: Discussionsupporting

confidence: 92%

HIV Self-Testing Implementation, Distribution and Use Among Female Sex Workers in Cotonou, Benin: A Qualitative Evaluation of Acceptability and Feasibility

Moreau¹,

Kintin²,

Atchekpe³

et al. 2021

Preprint

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“…Additional benefits include increased perceived security about one's health, economic empowerment, restored intimacy in relationships, and improved protection of one's sexual health [11][12][13]. Despite barriers associated with HIV self-testing such as the absence of counseling or the fear of partner reactions, randomized clinical trials show that the overwhelming majority of participants choose HIV self-testing over facility-based testing [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Correlations between oral Pre-Exposure Prophylaxis (PrEP) initiations and policies that enable the use of PrEP to address HIV globally

Tailor¹,

Rodrigues²,

Meade³

et al. 2022

PLOS Glob Public Health

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Policies facilitating access to HIV prevention services, specifically for pre-exposure prophylaxis (PrEP), can foster enabling environments for service uptake. This analysis aims to establish whether policies enabling broad PrEP eligibility, HIV self-testing, and lowered age of consent to HIV testing and treatment services are correlated with PrEP uptake. Ages of consent vary by country, therefore this analysis focused on how age of consent policies, in general, affect adolescent PrEP uptake. Data was collected from the HIV Policy Lab and AVAC’s Global PrEP Tracker, a database of approximately 334 PrEP projects operating across 95 countries, and linear regression and correlation analyses were conducted via STATA to examine relationships amongst national oral PrEP eligibility, HIV self-testing, lowered age of consent, and national cumulative oral PrEP initiations, as of December 2021. Of all 194 countries tracked by the HIV Policy Lab, only about 7% have adopted all three policies (HIV self-testing, lowered age of consent, and PrEP eligibility policies). Less than 50% have adopted have adopted at least one of these policies. Of the 54 countries that have fully adopted PrEP eligibility policies, less than 30% have co-adopted HIV self-testing or lowered age of consent policies. About 30% of these 194 countries have yet to adopt any of these policies, of which about 14% have indicated information is “unavailable” for at least one of the policies. Analyses conducted for the 91 countries tracked by both the HIV Policy Lab and the Global PrEP Tracker revealed a significant and positive relationship between cumulative individuals initiated on oral PrEP and adoption of HIV self-testing policies (p = 0.01, r = 0.26), lowered age of consent policies (p = 0.01, r = 0.25), and PrEP eligibility policies (p = 0.01, r = 0.26). Stronger advocacy efforts towards approving public health policies, such as those outlined in our analysis, that enshrine and enable access to HIV prevention are necessary.

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“…A growing body of evidence shows that HIVST is highly acceptable, feasible, convenient, and viewed as more confidential than standard testing services among harder-to-reach and higher-risk populations, including KPs [ 11 - 19 ]. According to early systematic reviews, HIVST, both supervised and unsupervised, had high acceptability among participants [ 18 ] and was preferred over standard testing as it was convenient and private [ 15 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have concluded that more information, research, and stronger programming to ensure linkage to confirmatory testing and treatment after HIVST is necessary [ 11 - 13 , 17 , 18 , 20 , 21 , 23 - 26 ]; however, few have actually explored this relationship [ 11 - 13 , 20 , 21 , 25 , 26 ]. Varying rates of linkage to confirmatory testing and treatment were found in studies that used both assisted and unassisted HIVST [ 11 - 13 , 20 , 25 - 27 ]. One systematic review and meta-analysis on unsupervised HIVST among MSM in high-resource countries reported a range of linkage to care from 31.3%-100% [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…One systematic review and meta-analysis on unsupervised HIVST among MSM in high-resource countries reported a range of linkage to care from 31.3%-100% [ 20 ]. There were a couple of studies that explored the relationship between unsupervised HIVST and linkage to treatment in KPs in Sub-Saharan African countries [ 11 , 12 ]. Both had high linkage rates; however, one had active follow-up and access to a KP-friendly drop-in-center component [ 12 ], and the other was not statistically significant from the standard service [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Increasing Testing Options for Key Populations in Burundi Through Peer-Assisted HIV Self-Testing: Descriptive Analysis of Routine Programmatic Data

Lillie¹,

Boyee²,

Kamariza³

et al. 2021

JMIR Public Health Surveill

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Background In Burundi, given the low testing numbers among key populations (KPs), peer-assisted HIV self-testing (HIVST) was initiated for female sex workers (FSWs), men who have sex with men (MSM), and transgender people to provide another testing option. HIVST was provided by existing peer outreach workers who were trained to provide support before, during, and after the administration of the test. People who screened reactive were referred and actively linked to confirmatory testing, and those confirmed positive were linked to treatment. Standard testing included HIV testing by clinical staff either at mobile clinics in the community or in facilities. Objective This study aims to improve access to HIV testing for underserved KPs, improve diagnoses of HIV serostatus among key populations, and link those who were confirmed HIV positive to life-saving treatment for epidemic control. Methods A descriptive analysis was conducted using routine programmatic data that were collected during a 9-month implementation period (June 2018 to March 2019) for peer-assisted HIVST among FSWs, MSM, and transgender people in 6 provinces where the US Agency for International Development–and US President’s Emergency Plan for AIDS Relief–funded LINKAGES (Linkage across the Continuum of HIV Services for KP Affected by HIV) Burundi project was being implemented. Chi-square tests were used to compare case-finding rates among individuals who were tested through HIVST versus standard testing. Multivariable logistic regression was performed to assess factors that were independently associated with HIV seropositivity among FSWs and MSM who used HIVST kits. Results A total of 2198 HIVST kits were administered (FSWs: 1791/2198, 81.48%; MSM: 363/2198, 16.52%; transgender people: 44/2198, 2%). HIV seropositivity rates from HIVST were significantly higher than those from standard testing for FSWs and MEM and nonsignificantly higher than those from standard testing for transgender people (FSWs: 257/1791, 14.35% vs 890/9609, 9.26%; P<.001; MSM: 47/363, 12.95% vs 90/2431, 3.7%; P<.001; transgender people: 10/44, 23% vs 6/36, 17%; P=.50). Antiretroviral therapy initiation rates were significantly lower among MSM who were confirmed to be HIV positive through HIVST compared to those among MSM who were confirmed to be HIV positive through standard testing (40/47, 85% vs 89/90, 99%; P<.001). No significant differences in antiretroviral therapy initiation rates were found between the FSW and transgender groups. Multivariable analyses among FSWs who used HIVST kits showed that being aged ≥25 years (adjusted odds ratio 1.9, 95% CI 1.4-2.6) and having >8 clients per week (adjusted odds ratio 1.3, 95% CI 1.0-1.8) were independently associated with HIV seropositivity. Conclusions The results demonstrate the potential effectiveness of HIVST in newly diagnosing underserved KPs and linking them to treatment.

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Formative assessment to identify perceived benefits and barriers of HIV oral self-testing among female sex workers, service providers, outreach workers, and peer educators to inform scale-up in Kenya

Cited by 5 publications

References 24 publications

HIV Self-Testing Implementation, Distribution and Use Among Female Sex Workers in Cotonou, Benin: A Qualitative Evaluation of Acceptability and Feasibility

HIV Self-Testing Implementation, Distribution and Use Among Female Sex Workers in Cotonou, Benin: A Qualitative Evaluation of Acceptability and Feasibility

Correlations between oral Pre-Exposure Prophylaxis (PrEP) initiations and policies that enable the use of PrEP to address HIV globally

Increasing Testing Options for Key Populations in Burundi Through Peer-Assisted HIV Self-Testing: Descriptive Analysis of Routine Programmatic Data

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