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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.
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