Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia

Abstract

Objectives To assess the effect of two health systems approaches to distribute HIV self-tests on the number of female sex workers’ client and non-client sexual partners in a randomized controlled trial of HIV self-testing among female sex workers (FSW) in Zambia. Design Cluster randomized controlled trial. Methods Peer educators recruited 965 participants. Peer educator-participant groups were randomized 1:1:1 to one of three arms: 1) delivery of HIV self-tests directly from a peer educator, 2) free facility-based delivery of HIV-self tests in exchange for coupons, or 3) referral to standard HIV testing (standard of care). Participants in all three arms completed four peer educator intervention sessions, which included counseling and condom distribution. Participants were asked the average number of client partners they had per night at baseline, one and four months, and the number of non-client partners they had in the past 12 months (at baseline) and in the past month (at one month and four months). Results At four months, participants reported significantly fewer clients per night in the delivery arm (mean difference −0.78 clients, 95% CI −1.28 to −0.28, P=0.002) and the coupon arm (−0.71, 95% CI −1.21 to −0.21, P=0.005) compared to standard-of-care. Similarly, they reported fewer non-client partners in the delivery (−3.19, 95% CI −5.18 to −1.21, P=0.002) and in the coupon arm (−1.84, 95% CI −3.81 to 0.14, P=0.07) arm compared to standard-of-care. Conclusions Expansion of HIV self-testing may have positive spillover effects on HIV prevention efforts among FSW in Zambia. Trial Registration ClinicalTrials.gov NCT02827240

Diagnosis of Human Immunodeficiency Virus Infection

“…HIV self-testing empowers patients and will allow access to populations that cannot be reached using existing services. Many at-risk persons refrain from testing due to fear of discrimination or stigmatization (62); thus, home-based testing provides them an avenue to access testing in privacy. In Malawi, acceptability was high in antenatal clinics where self-testing was offered to pregnant women and their male partners (63).…”

Social network strategy as a promising intervention to better reach key populations for promoting HIV prevention: a systematic review and meta-analysis

“…Among the 28 trials, 11 were conducted in DUs,10 18–20 23 27 32 34–36 39 6 in MSM,17 21 22 25 26 38 8 in FSWs,29–31 33 and 1 in bisexual or transgender persons 26. The remaining three articles were done among the populations who were at sexual high-risk or lived in high-risk areas including high-risk Roma men (80% had unprotected intercourse and 59% had multiple sexual partners),24 sexual high-risk (95% had high-risk sexual behaviour and 12% reported HIV positive) women37 and low-income, inner-city housing developments’ women (50% had unprotected intercourse),28 respectively.…”

“…Seed-peer leader intervention was applied in 17 cluster RCTs,10 17–20 23–26 28–31 34–37 in which seeds participated in training sessions to work as peer leaders, delivering HIV intervention to their social network members (SNMs), whereas reselected peer leader intervention was conducted in the other two cluster RCTs,21 22 where network leadership was identified in each network cluster through sociometric scores, and SNMs received intervention from those reselected peer leaders. When seeds had dyad sessions to receive HIV intervention together with SNMs, the form of social network intervention was called seed & SNM dyad intervention 27 32 33 38 39…”

“…Members of the same social network often shared similar norms, attitudes and HIV risk behaviour, and they knew and trusted each other 40. Therefore, the social network was used to access key populations 10 17–39. Additionally, the social network played an essential role in diffusing HIV risk information through seeds or peer leaders to their SNMs 10 17–28 32–39.…”

Sources of social support and sexual behaviour advice for young adults in rural South Africa

“…One way of improving intervention engagement and uptake is delivery through peers or influential others 7 8. This approach to improving intervention effectiveness in real-life roll-out of interventions draws on an understanding of social networks 9.…”