HIV self-testing (HIVST) may play a role in addressing gaps in HIV testing coverage and as an entry point for HIV prevention services by empowering individuals to test themselves and reducing stigma-related barriers to HIV testing. We evaluated two health systems delivery approaches for HIVST distribution compared to referral to standard testing among female sex workers in Zambia. Trained peer educators in Kapiri, Chirundu, and Livingstone, Zambia each recruited 6 FSW participants. Peer educator-FSW groups were randomized to one of three arms: 1) delivery (direct distribution of an oral HIVST from the peer educator), 2) coupon (a coupon for collection of an oral HIVST from a health clinic/pharmacy), or 3) standard-of-care HIV testing. Participants in the two HIVST arms received two kits: one at baseline and one at three months. The primary outcome was any self-reported HIV testing in the past month at the one- and four-month visits, as HIV self-testing can replace other parts of HIV testing. Secondary endpoints included linkage to care, HIVST use in the intervention arms, adverse events, empowerment, sexual behaviors, and measures of stigma. Participants completed questionnaires at one and four months following peer educator interventions.965 participants were enrolled (delivery: N=322, coupon, N=323, standard, N=320); 20% had never tested for HIV. Overall HIV testing at one month was 94.9% in the delivery arm, 84.4% coupon, and 88.5% standard-of-care. Four month rates were 84.1% delivery, 79.8% coupon and 75.1% standard. HIV self-test use was higher in the delivery arm compared to the coupon arm (RR=1.14, 95% CI 1.05–1.23, P=0.001) at one month but there was no difference in at four months. Among participants reporting a positive HIV test at one (N=144) and four months (N=235), linkage to care was non-significantly lower in the two HIVST arms compared to the standard-of-care arms. 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. HIV self-testing coverage was high in all arms, suggesting that HIV self-testing is able to overcome stigma-related barriers to HIV testing in this population.
Disclosure No significant relationships.
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