Self-Testing for HIV Accepted by African Sex Workers

PARIS -- HIV testing kits given to sex workers in Zambia were used extensively by participants in a randomized clinical trial -- though rates were no different than when performed at standard clinical office visits, researchers reported here.

Similarly, no differences were seen at 4 months in the percentage of participants who used self-testing kits delivered directly to the sex workers versus picking them up at pharmacies with coupons, said Catherine Oldenburg, PhD, of the University of California San Francisco.

In her oral presentation at the International AIDS Society Conference on HIV Science, Oldenburg reported, "HIV self-testing was highly used by participants, but did not increase HIV testing rates relative to standard of care."

Importantly, she said, use of self-testing kits did not appear to increase the risk of intimate partner violence. There were three cases of intimate partner violence among the 965 sex workers involved in the study, she said. She said that as many as 60% of sex workers report intimate partner violence whereas, in the study, the rate was about 0.3%.

Oldenburg and colleagues assigned 320 of the sex workers to standard of care (testing at clinic visits); 316 were directly given the self-test kits; and 329 sex workers were given coupons that could be exchanged for self-test kits at drug stores or clinics. Overall, 93.1% of the participants completed the 4-month trial. She said that 20% of the participants had never had an HIV test before.

After 1 month 95% of the sex workers who were directly given the kits had performed a self test for HIV infection. About 84% of the sex workers who were given coupons had collected the kits and had performed the test. About 89% of the sex workers who received standard care also had undergone an HIV status test after one month. Oldenburg said those results were not significantly different.

The WHO recommends testing every 3 months for individuals at high risk for acquiring HIV infection, so the sex workers were provided with two test kits, one to be used within 1 month of the trial and the other 3 months later. Oldenburg said that by the end of the trial, only one of the participants had not used at least one kit.

"We were very surprised that all these strategies worked so well with sex workers," Oldenburg told MedPage Today. "I think that by providing choices for delivery of these kits the sex workers will benefit in knowing their status and by being able to link to care if they become HIV-positive." She said that it appeared that sex workers were aware of their risks of contracting HIV infection and were keen on finding out their status.

She said that the goal of the study was to provide a way for sex workers to overcome barriers to testing, including discrimination and stigmatization from the health care community.

Sex workers were eligible for the study if they were adults; had exchanged sex for money or other goods within the past month; were either HIV negative or had unknown HIV status; had not been tested in the past 3 months; and lived in the communities of Livingstone, Kapiri Mposhi or Chirundu in Zambia. The participants completed questionnaires at baseline, at the end of one month, and at the end of 4 months.

Mean participant age was about 25. By the end of the 4-month trial, 235 women in the group were found to be HIV positive. About 75% of those women were subsequently linked to care and 25% to 50% of these women were being treated with antiretrovirals.

Oldenburg said it was likely that the study, while conducted solely at sites in Zambia, would be applicable in other similar populations across Africa.

Press conference moderator Linda-Gail Bekker, MD, president of the International AIDS Society, emphasized that in trying to meet the WHO 90-90-90 goals -- 90% of individuals with HIV diagnosed, 90% of that group getting into treatment, and 90% having virus suppressed to undetectable levels -- the first step is getting people tested. She said the results make it clear that the women in the trial were eager to know their HIV status.

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