Acceptability of HIV self-testing to support pre-exposure prophylaxis among female sex workers in Uganda and Zambia: results from two randomized controlled trials

Katrina F Ortblad, Michael M Chanda, Daniel Kibuuka Musoke, Thomson Ngabirano, Magdalene Mwale, Aidah Nakitende, Steven Chongo, Nyambe Kamungoma, Catherine Kanchele, Till Bärnighausen, Catherine E Oldenburg, Katrina F Ortblad, Michael M Chanda, Daniel Kibuuka Musoke, Thomson Ngabirano, Magdalene Mwale, Aidah Nakitende, Steven Chongo, Nyambe Kamungoma, Catherine Kanchele, Till Bärnighausen, Catherine E Oldenburg

Abstract

Background: HIV pre-exposure prophylaxis (PrEP) is highly effective for prevention of HIV acquisition, but requires HIV testing at regular intervals. Female sex workers (FSWs) are a priority population for HIV prevention interventions in many settings, but face barriers to accessing healthcare. Here, we assessed the acceptability of HIV self-testing for regular HIV testing during PrEP implementation among FSWs participating in a randomized controlled trial of HIV self-testing delivery models.

Methods: We used data from two HIV self-testing randomized controlled trials with identical protocols in Zambia and in Uganda. From September-October 2016, participants were randomized in groups to: (1) direct delivery of an HIV self-test, (2) delivery of a coupon, exchangeable for an HIV self-test at nearby health clinics, or (3) standard HIV testing services. Participants completed assessments at baseline and 4 weeks. Participants reporting their last HIV test was negative were asked about their interest in various PrEP modalities and their HIV testing preferences. We used mixed effects logistic regression models to measure differences in outcomes across randomization arms at four weeks.

Results: At 4 weeks, 633 participants in Zambia and 749 participants in Uganda reported testing negative at their last HIV test. The majority of participants in both studies were "very interested" in daily oral PrEP (91% Zambia; 66% Uganda) and preferred HIV self-testing to standard testing services while on PrEP (87% Zambia; 82% Uganda). Participants in the HIV self-testing intervention arms more often reported preference for HIV self-testing compared to standard testing services to support PrEP in both Zambia (P = 0.002) and Uganda (P < 0.001).

Conclusion: PrEP implementation programs for FSW could consider inclusion of HIV self-testing to reduce the clinic-based HIV testing burden.

Trial registration: ClinicalTrials.gov NCT02827240 and NCT02846402 .

Keywords: Female sex workers; HIV self-testing; Pre-exposure prophylaxis; Uganda; Zambia.

Conflict of interest statement

Ethics approval and consent to participate

Both studies were reviewed and approved by the Institutional Review Board at the Harvard T.H. Chan School of Public Health. The Zambia study was reviewed and approved by the Institutional Review Board at ERES Converge (Lusaka, Zambia) and the Uganda study was reviewed and approved by the Institutional Review Board at Mildmay (Kampala, Uganda). Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of participants included in the study in both Zambia and Uganda
Fig. 2
Fig. 2
Proportion of participants reporting to be “very interested” in PrEP modality in Zambia and Uganda
Fig. 3
Fig. 3
Percentage of participants with a preference for HIV self-testing (HIVST) or standard HIV testing at a clinic while taking PrEP by study randomization in Zambia and Uganda

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