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

Abstract

BACKGROUND The HIV epidemic in Indonesia continues to be concentrated among key populations including female sex workers (FSW). However, increasing HIV testing among this sub-population continues to be a challenge, necessitating exploration into alternatives testing modalities. OBJECTIVE The objective of this study was to test whether the addition of oral fluid test as an alternative testing modality will increase the number of FSW who receive HIV testing. METHODS We undertook a community-randomized trial in 23 national priority districts with existing package of HIV community outreach services. The trial consisted of 15 intervention districts and 8 control districts. In the control districts, implementing units of HIV program administered the standard of care while in the intervention districts, an additional HIV self-testing option using oral fluid test was given as a community-based screening. Participants with reactive screening results will be encouraged to undergo HIV testing at a health facility to confirm their diagnosis and subsequent antiretroviral treatment. Multiple means of recruitment were deployed including through outreach workers and social media campaign. Due in large part to the COVID-19 pandemic, most research activities were conducted online. RESULTS 17,962 FSWs were reached in the intervention sites, 45.5% (n=8,176/17,962) accepted testing, 18.9% of whom accepted OFT (n= 1,545/8,176). A total of 1.3% (n=106/8,176) participants were confirmed HIV positive. In the control districts, 7,653 FSWs were reached, 45.4% (n=3,471/7.653) received testing, 0.8% (n=29/3,471) were confirmed HIV positive. Post-test surveys for participants receiving OFT indicated overall high satisfaction and intention to use. Through the social media campaign, there were also people who registered independently for OFT but did not identify as FSW. They were eventually not eligible to participate but their interest point to the possibility of implementing HIV self-testing to general population. CONCLUSIONS The addition of HIV self-testing to standard of care supported by a web-based data collection system was able to result in higher HIV testing and higher case finding among female sex workers in Indonesia. High satisfaction of OFT users and the interest of general population towards this alternative testing modality are promising for scaling up this strategy nationally. CLINICALTRIAL ClinicalTrials.gov, number NCT04578145