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

Jessie Olivia Yunus, Anak Agung Sagung Sawitri, Dewa Nyoman Wirawan, I Gusti Agung Agus Mahendra, Dewi Susanti, Ni Kadek Ayu Dwi Utami Ds, Dedison Asanab, Ida Ayu Narayani, Oldri Sherli Mukuan, Asti Widihastuti, Robert Magnani, Pande Putu Januraga, Jessie Olivia Yunus, Anak Agung Sagung Sawitri, Dewa Nyoman Wirawan, I Gusti Agung Agus Mahendra, Dewi Susanti, Ni Kadek Ayu Dwi Utami Ds, Dedison Asanab, Ida Ayu Narayani, Oldri Sherli Mukuan, Asti Widihastuti, Robert Magnani, Pande Putu Januraga

Abstract

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://ichgcp.net/clinical-trials-registry/NCT04578145.

International registered report identifier (irrid): RR1-10.2196/27168.

Keywords: HIV; Indonesia; community-based screening; female sex worker; oral fluid test; self-testing.

Conflict of interest statement

Conflicts of Interest: Principal investigators and research staff were sponsored by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to perform the study independently. None of the personnel involved in this study received financial compensation from the OFT kit manufacturer.

©Jessie Olivia Yunus, Anak Agung Sagung Sawitri, Dewa Nyoman Wirawan, I Gusti Agung Agus Mahendra, Dewi Susanti, Ni Kadek Ayu Dwi Utami Ds, Dedison Asanab, Ida Ayu Narayani, Oldri Sherli Mukuan, Asti Widihastuti, Robert Magnani, Pande Putu Januraga. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 21.07.2021.

Figures

Figure 1
Figure 1
HIV program network in Indonesia. MoH: Ministry of Health; UNFPA: United Nations Population Fund.
Figure 2
Figure 2
Study flowchart outlining processes in the intervention and control arms. ART: antiretroviral therapy; OFT: oral fluid test; OW: outreach worker.
Figure 3
Figure 3
Timeline of the intervention arm showing processes for different types of HIV tests chosen. ART: antiretroviral therapy; OFT: oral fluid test; OW: outreach worker.
Figure 4
Figure 4
Adapted Technology Acceptance Model framework for analysis of the perception toward oral fluid test (OFT) use.

References

    1. Regional Office for South-East Asia, World Health Organization Progress report on HIV in the WHO South-East Asia Region, 2016. World Health Organization. 2016. [2020-08-29]. .
    1. UNAIDS Data 2019. Joint United Nations Programme on HIV/AIDS. 2019. [2020-08-29]. .
    1. Estimasi dan proyeksi HIV AIDS di Indonesia tahun 2019-2024. Direktorat Jenderal Pencegahan dan Pengendalian Penyakit, Kementerian Kesehatan Republik Indonesia. 2020. [2021-07-15]. .
    1. Rencana Aksi Nasional Pencegahan dan Pengendalian HIV AIDS dan PIMS di Indonesia Tahun 2020-2024. Kementerian Kesehatan Republik Indonesia. 2020. [2020-09-29]. .
    1. Dampak Penutupan Lokalisasi/Lokasi Di Empat Kota. Pusat Penelitian HIV & AIDS UNIKA Atma Jaya. 2016. [2020-08-29]. .
    1. Cantelmo C, Soehoed R, Lee B, Ross R. Costs of Strengthening the HIV Treatment Cascade in Jakarta, Indonesia. 2019. [2020-08-29]. .
    1. A Short Technical Update on Self-Testing for HIV. Joint United Nations Programme on HIV/AIDS. 2014. [2020-09-29]. .
    1. Tokar A, Broerse JEW, Blanchard J, Roura M. HIV Testing and Counseling Among Female Sex Workers: A Systematic Literature Review. AIDS Behav. 2018 Aug 20;22(8):2435–2457. doi: 10.1007/s10461-018-2043-3.
    1. Kerrigan DL, Fonner VA, Stromdahl S, Kennedy CE. Community empowerment among female sex workers is an effective HIV prevention intervention: a systematic review of the peer-reviewed evidence from low- and middle-income countries. AIDS Behav. 2013 Jul;17(6):1926–40. doi: 10.1007/s10461-013-0458-4.
    1. Shahmanesh M, Patel V, Mabey D, Cowan F. Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review. Trop Med Int Health. 2008 May 13;13(5):659–79. doi: 10.1111/j.1365-3156.2008.02040.x. doi: 10.1111/j.1365-3156.2008.02040.x.
    1. Wariki WMV, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005272. doi: 10.1002/14651858.CD005272.pub3.
    1. Wirtz AL, Pretorius C, Beyrer C, Baral S, Decker MR, Sherman SG, Sweat M, Poteat T, Butler J, Oelrichs R, Semini I, Kerrigan D. Epidemic impacts of a community empowerment intervention for HIV prevention among female sex workers in generalized and concentrated epidemics. PLoS One. 2014 Feb 6;9(2):e88047. doi: 10.1371/journal.pone.0088047.
    1. Consolidated Guidelines on HIV Testing Services. World Health Organization. 2015. [2020-08-29]. .
    1. Deering K, Montaner J, Chettiar J, Jia J, Ogilvie G, Buchner C, Feng C, Strathdee S, Shannon K. Successes and gaps in uptake of regular, voluntary HIV testing for hidden street- and off-street sex workers in Vancouver, Canada. AIDS Care. 2015 Nov 27;27(4):499–506. doi: 10.1080/09540121.2014.978730.
    1. Yi H, Mantell JE, Wu R, Lu Z, Zeng J, Wan Y. A profile of HIV risk factors in the context of sex work environments among migrant female sex workers in Beijing, China. Psychol Health Med. 2010 Mar 24;15(2):172–87. doi: 10.1080/13548501003623914.
    1. HIV Self-testing Strategic Framework: A Guide for Planning, Introducing and Scaling Up. World Health Organization. 2018. [2020-08-29]. .
    1. Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and Acceptability on HIV Self-testing Among Key Populations: A Literature Review. AIDS Behav. 2015 Nov;19(11):1949–65. doi: 10.1007/s10461-015-1097-8.
    1. Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, Sands A, Baggaley R. Examining the effects of HIV self‐testing compared to standard HIV testing services: a systematic review and meta‐analysis. Journal of the International AIDS Society. 2017 May 15;20(1):21594. doi: 10.7448/ias.20.1.21594.
    1. Krause J, Subklew-Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health. 2013 Aug 08;13:735. doi: 10.1186/1471-2458-13-735.
    1. Platteau T, Fransen K, Apers L, Kenyon C, Albers L, Vermoesen T, Loos J, Florence E. Swab2know: An HIV-Testing Strategy Using Oral Fluid Samples and Online Communication of Test Results for Men Who Have Sex With Men in Belgium. J Med Internet Res. 2015 Sep 01;17(9):e213. doi: 10.2196/jmir.4384.
    1. Shava E, Manyake K, Mdluli C, Maribe K, Monnapula N, Nkomo B, Mosepele M, Moyo S, Mmalane M, Bärnighausen T, Makhema J, Bogart LM, Lockman S. Acceptability of oral HIV self-testing among female sex workers in Gaborone, Botswana. PLoS One. 2020 Jul 27;15(7):e0236052. doi: 10.1371/journal.pone.0236052.
    1. Suntharasamai P, Martin M, Choopanya K, Vanichseni S, Sangkum U, Tararut P, Leelawiwat W, Anekvorapong R, Mock PA, Cherdtrakulkiat T, Leethochawalit M, Chiamwongpaet S, Gvetadze RJ, McNicholl JM, Paxton LA, Kittimunkong S, Curlin ME. Assessment of Oral Fluid HIV Test Performance in an HIV Pre-Exposure Prophylaxis Trial in Bangkok, Thailand. PLoS One. 2015;10(12):e0145859. doi: 10.1371/journal.pone.0145859.
    1. Chanda MM, Ortblad KF, Mwale M, Chongo S, Kanchele C, Kamungoma N, Fullem A, Dunn C, Barresi LG, Harling G, Bärnighausen T, Oldenburg CE. HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial. PLoS Med. 2017 Nov 21;14(11):e1002442. doi: 10.1371/journal.pmed.1002442.
    1. Napierala S, Desmond NA, Kumwenda MK, Tumushime M, Sibanda EL, Indravudh P, Hatzold K, Johnson CC, Baggaley RC, Corbett L, Cowan FM. HIV self-testing services for female sex workers, Malawi and Zimbabwe. Bull. World Health Organ. 2019 Sep 03;97(11):764–776. doi: 10.2471/blt.18.223560.
    1. Nguyen VTT, Phan HT, Kato M, Nguyen Q, Le Ai KA, Vo SH, Thanh DC, Baggaley RC, Johnson CC. Community-led HIV testing services including HIV self-testing and assisted partner notification services in Vietnam: lessons from a pilot study in a concentrated epidemic setting. J Int AIDS Soc. 2019 Jul 19;22 Suppl 3(Suppl 3):e25301. doi: 10.1002/jia2.25301.
    1. Ortblad KF, Kibuuka Musoke D, Ngabirano T, Nakitende A, Taasi G, Barresi LG, Bärnighausen T, Oldenburg CE. HIV self-test performance among female sex workers in Kampala, Uganda: a cross-sectional study. BMJ Open. 2018 Nov 08;8(11):e022652. doi: 10.1136/bmjopen-2018-022652.
    1. Hidayat R, Marguari D, Hairunisa N, Suparno H, Magnani R. Community HIV Screening Among MSM in Three Indonesian Cities. CHR. 2019 Jul 11;17(1):65–71. doi: 10.2174/1570162x17666190321115419.
    1. Januraga PP, Reekie J, Mulyani T, Lestari BW, Iskandar S, Wisaksana R, Kusmayanti NA, Subronto YW, Widyanthini DN, Wirawan DN, Wongso LV, Sudewo AG, Sukmaningrum E, Nisa T, Prabowo BR, Law M, Cooper DA, Kaldor JM. The cascade of HIV care among key populations in Indonesia: a prospective cohort study. The Lancet HIV. 2018 Oct;5(10):e560–e568. doi: 10.1016/s2352-3018(18)30148-6.
    1. Wulandari LPL, Kaldor J, Guy R. Uptake and acceptability of assisted and unassisted HIV self-testing among men who purchase sex in brothels in Indonesia: a pilot intervention study. BMC Public Health. 2020 May 19;20(1):730. doi: 10.1186/s12889-020-08812-4.
    1. Merchant RC, Romanoff J, Clark MA, Liu T, Rosenberger JG, Bauermeister J, Mayer KH. Variations in Recruitment Yield and Characteristics of Participants Recruited Across Diverse Internet Platforms in an HIV Testing Study of Young Adult Men-Who-Have-Sex-With-Men (YMSM) Am J Mens Health. 2017 Sep;11(5):1342–1357. doi: 10.1177/1557988317717383.
    1. Sullivan PS, Zahn RJ, Wiatrek S, Chandler CJ, Hirshfield S, Stephenson R, Bauermeister JA, Chiasson MA, Downing MJ, Gelaude DJ, Siegler AJ, Horvath K, Rogers E, Alas A, Olansky EJ, Saul H, Rosenberg ES, Mansergh G. HIV Prevention Via Mobile Messaging for Men Who Have Sex With Men (M-Cubed): Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2019 Nov 15;8(11):e16439. doi: 10.2196/16439.
    1. Op de Coul E, den Daas C, Spijker R, Heijman T, de Vos M, Götz H, Vermey K, Zuilhof W, Van den Boogaard J, Davidovich U, Zuure F, PREVENT Collaborators Web-Supported Social Network Testing for HIV Among Men Who Have Sex With Men With a Migration Background: Protocol for a Mixed Methods Pilot Study. JMIR Res Protoc. 2020 Feb 09;9(2):e14743. doi: 10.2196/14743.
    1. Curtis BL. Social networking and online recruiting for HIV research: ethical challenges. J Empir Res Hum Res Ethics. 2014 Feb;9(1):58–70. doi: 10.1525/jer.2014.9.1.58.
    1. Stephenson R, Freeland R, Sullivan SP, Riley E, Johnson BA, Mitchell J, McFarland D, Sullivan PS. Home-Based HIV Testing and Counseling for Male Couples (Project Nexus): A Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2017 May 30;6(5):e101. doi: 10.2196/resprot.7341.
    1. Stephenson R, Metheny N, Sharma A, Sullivan S, Riley E. Providing Home-Based HIV Testing and Counseling for Transgender Youth (Project Moxie): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2017 Nov 28;6(11):e237. doi: 10.2196/resprot.8562.
    1. Horvath KJ, Walker T, Mireles L, Bauermeister JA, Hightow-Weidman L, Stephenson R. A Systematic Review of Technology-Assisted HIV Testing Interventions. Curr HIV/AIDS Rep. 2020 Aug;17(4):269–280. doi: 10.1007/s11904-020-00506-1.
    1. Fielding H, McCallum L, Sebayang M, Burrows D, Parsons D. Assessment of HIV Servcie Packages for Key Populations in Indonesia. APMG Health. 2018. [2020-09-29]. .
    1. Boslaugh S. Encyclopedia of Epidemiology. Thousand Oaks, CA: SAGE Publications Inc; 2008.
    1. Ng OT, Chow AL, Lee VJ, Chen MIC, Win MK, Tan HH, Chua A, Leo YS. Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test. PLoS One. 2012;7(9):e45168. doi: 10.1371/journal.pone.0045168.
    1. Pai N, Balram B, Shivkumar S, Martinez-Cajas Jl, Claessens C, Lambert G, Peeling RW, Joseph L. Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2012 May;12(5):373–380. doi: 10.1016/S1473-3099(11)70368-1. doi: 10.1016/s1473-3099(11)70368-1.
    1. Lwanga S, Lemeshow S. Sample size determination in health studies: a practical manual. World Health Organization. 1991. [2020-08-29]. .
    1. Listyani RH. Pencegahan Praktik Prostitusi Online Melalui Lembaga Sekolah dan Keluarga. JSM. 2017 Oct 31;1(2):67–75. doi: 10.26740/jsm.v1n2.p67-74.
    1. Irfani F. Merekam Solidaritas Pekerja Seks Ibu Kota, Ketika Ranjang Jadi Hening Akibat Pandemi. VICE. [2020-06-29]. .
    1. Bavinton B, Mahendra I, Law M, Kaldor J, Wirawan DN, Grulich AE, Januraga PP. Study report: Survei Kesehatan Seksual Indonesia 2018. Center for Public Health Innovation, Kirby Institute. 2019. [2020-09-29]. .
    1. Cunningham S, Sanders T, Scoular J, Campbell R, Pitcher J, Hill K, Valentine-Chase M, Melissa C, Aydin Y, Hamer R. Behind the screen: Commercial sex, digital spaces and working online. Technology in Society. 2018 May;53:47–54. doi: 10.1016/j.techsoc.2017.11.004.
    1. Broady T, Power C, Mao L, Bavinton B, Chan C, Bambridge C, Mackie B, Fraser N, Prestage G, Holt M. Gay Community Periodic Survey: Sydney 2019. Centre for Social Research in Health, UNSW Sydney. 2019. [2020-09-29]. .
    1. Callander D, Newman CE, Holt M, Rosenberg S, Duncan DT, Pony M, Timmins L, Cornelisse V, Duck-Chong L, Wang B, Cook T. The Complexities of Categorizing Gender: A Hierarchical Clustering Analysis of Data from the First Australian Trans and Gender Diverse Sexual Health Survey. Transgender Health. 2021 Apr 01;6(2):74–81. doi: 10.1089/trgh.2020.0050.
    1. Biello KB, Marrow E, Mimiaga MJ, Sullivan P, Hightow-Weidman L, Mayer KH. A Mobile-Based App (MyChoices) to Increase Uptake of HIV Testing and Pre-Exposure Prophylaxis by Young Men Who Have Sex With Men: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc. 2019 Jan 07;8(1):e10694. doi: 10.2196/10694.
    1. Reinius M, Wettergren L, Wiklander M, Svedhem V, Ekström AM, Eriksson LE. Development of a 12-item short version of the HIV stigma scale. Health Qual Life Outcomes. 2017 May 30;15(1):115. doi: 10.1186/s12955-017-0691-z.
    1. Davis FD. A Technology Acceptance Model for Empirically Testing New End-User Information Systems. MIT Libraries. 1986. [2021-06-30]. .
    1. Pre-exposure prophylaxis services in Thailand during COVID-19. World Health Organization. [2020-06-29]. .
    1. Wang Z, Lau JTF, Ip M, Ho SPY, Mo PKH, Latkin C, Ma YL, Kim Y. A Randomized Controlled Trial Evaluating Efficacy of Promoting a Home-Based HIV Self-Testing with Online Counseling on Increasing HIV Testing Among Men Who Have Sex with Men. AIDS Behav. 2018 Jan;22(1):190–201. doi: 10.1007/s10461-017-1887-2.
    1. Cao B, Gupta S, Wang J, Hightow-Weidman LB, Muessig KE, Tang W, Pan S, Pendse R, Tucker JD. Social Media Interventions to Promote HIV Testing, Linkage, Adherence, and Retention: Systematic Review and Meta-Analysis. J Med Internet Res. 2017 Nov 24;19(11):e394. doi: 10.2196/jmir.7997.
    1. Chan PS, Chidgey A, Lau J, Ip M, Lau JT, Wang Z. Effectiveness of a Novel HIV Self-Testing Service with Online Real-Time Counseling Support (HIVST-Online) in Increasing HIV Testing Rate and Repeated HIV Testing among Men Who Have Sex with Men in Hong Kong: Results of a Pilot Implementation Project. Int J Environ Res Public Health. 2021 Jan 15;18(2):729. doi: 10.3390/ijerph18020729.
    1. Hatzold K, Gudukeya S, Mutseta MN, Chilongosi R, Nalubamba M, Nkhoma C, Munkombwe H, Munjoma M, Mkandawire P, Mabhunu V, Smith G, Madidi N, Ahmed H, Kambeu T, Stankard P, Johnson CC, Corbett EL. HIV self-testing: breaking the barriers to uptake of testing among men and adolescents in sub-Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe. J Int AIDS Soc. 2019 Mar;22 Suppl 1(Suppl 1):e25244. doi: 10.1002/jia2.25244.
    1. Luis H, Fridayantara WD, Mahariski P, Wignall FS, Irwanto I, Gedela K. Evolving ART crisis for people living with HIV in Indonesia. The Lancet HIV. 2020 Jun;7(6):e384–e385. doi: 10.1016/S2352-3018(20)30138-7.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe