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High uptake of HIV self testing by female sex workers in African countries
Roger Pebody, 2017-07-25 06:00:00

A year ago there was virtually no evidence on the acceptability and feasibility of HIV self testing in female sex workers, but a series of presentations from Zimbabwe, Zambia, Uganda and Kenya at the 9th International AIDS Society Conference on HIV Science (IAS 2017) in Paris, France, this week suggest that self-testing has potential in improving the uptake of testing among sex workers in Africa.

Self-testing might have advantages for sex workers of privacy and flexibility, allowing women to test themselves at a time of their choosing, without needing to fit in with the hours of clinical services, or to interact with healthcare workers who may have stigmatising attitudes. Its convenience may also make regular, repeat testing more feasible.

Policy makers have great interest in self testing because they hope it may be a more acceptable option for groups of people who have limited engagement with existing HIV testing services. The proportion of people living with HIV who remain undiagnosed is particularly high in some groups and sub-populations, including female sex workers.

Sue Mavedzenge of RTI International reported on work she has done in Zimbabwe. Female sex workers are disproportionately affected by HIV (prevalence over 50%, compared to 14% in the general population), but their engagement with health services does not reflect their heightened risk. Of all sex workers living with HIV, only 64% are aware of their status, 43% are taking HIV treatment, and 34% are virally suppressed. Increasing HIV testing is the necessary first step to better engagement with both prevention and treatment services.

When self testing was given as an option to around 600 women seeking HIV testing in a dedicated sex worker clinic, 54% chose the self-testing option. Self testing doesn’t need to take place at home, and in fact 96% of those using the self-testing kit did so in a private room at the clinic. This gives the possibility of seeking staff assistance in case of difficulty or of dealing with a reactive result – which 30% of those testing did have.

In follow-up questionnaires, 100% said the test was easy to use, 100% trusted the result they had been given and 98% were comfortable learning the result without someone else present. Substantial proportions expressed a willingness to pay for testing kits (for example, 36% said they would be willing to pay under USD$1 and 27% would be willing to pay between USD$2 and USD$3).

Of those testing positive, 99% had connected with follow-up services within two weeks of the test.

What’s the best way to distribute self-test kits to sex workers? Among the Zimbabwean respondents, there were preferences for distribution through clinics (62%), pharmacies (18%), peer networks (14%) and workplaces (13%). However this was a sample of sex workers recruited through clinics and there was also recognition that not all sex workers are engaged with clinics.