scholarly journals Web-based multifaceted approach in community-based screening in HIV self-testing: protocol for randomized community trial among female sex workers in Indonesia (Preprint)

2021 ◽  
Author(s):  
Jessie Olivia Yunus ◽  
Anak Agung Sagung Sawitri ◽  
Dewa Nyoman Wirawan ◽  
I Gusti Agung Agus Mahendra ◽  
Dewi Susanti ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Standard Of Care ◽  
Community Based ◽  
Web Based ◽  
Female Sex ◽  
Self Testing ◽  
High Satisfaction ◽  
Fluid Test

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

scholarly journals Web-based, multifaceted approach for community-based HIV self-testing among female sex workers in Indonesia: Protocol for a randomized community trial (Preprint)

10.2196/27168 ◽  
2021 ◽  
Author(s):  
Jessie Olivia Yunus ◽  
Anak Agung Sagung Sawitri ◽  
Dewa Nyoman Wirawan ◽  
I Gusti Agung Agus Mahendra ◽  
Dewi Susanti ◽  
...  
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
Community Based ◽  
Web Based ◽  
Multifaceted Approach ◽  
Female Sex ◽  
Self Testing ◽  
Community Trial

scholarly journals HIV testing and its associated factors among street-based female sex workers in Iran: results of a national rapid assessment and response survey

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sina Ahmadi ◽  
Mehrdad Khezri ◽  
Payam Roshanfekr ◽  
Salah Eddin Karimi ◽  
Meroe Vameghi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Associated Factors ◽  
Female Sex Workers ◽  
Rapid Assessment ◽  
Evidence Based ◽  
Multivariable Model ◽  
Sexually Transmitted ◽  
Female Sex ◽  
Self Testing

Abstract Background Female sex workers (FSWs) are at a disproportionate risk of sexually transmitted infections and they may face significant barriers to HIV testing. This study aimed to examine HIV testing prevalence and its associated factors among street-based FSWs in Iran. Method A total of 898 FSWs were recruited from 414 venues across 19 major cities in Iran between October 2016 and March 2017. Eligible FSWs were women aged 18 years of age who had at least one commercial sexual intercourse in the previous year. HIV testing was defined as having tested for HIV in the lifetime. Bivariable and multivariable logistic regression were used to examine the correlates of HIV testing. We report adjusted odds ratios (aOR) and their 95% confidence intervals (CI). Result Overall, 57.8% (95%CI: 20.0, 88.0) of participants reported having tested for HIV, and HIV prevalence among FSWs who tested for HIV was 10.3% (95%CI: 7.5, 13.0). The multivariable model showed that unstable housing (aOR: 8.86, 95%CI: 2.68, 29.32) and drug use (aOR: 3.47, 95%CI: 1.33, 9.06) were associated with increased likelihood of HIV testing. However, FSWs with a higher level of income were less likely to be tested for HIV (aOR: 0.09, 95%CI: 0.02, 0.43). Conclusion Almost one in ten street-based FSWs had never tested for HIV. These findings suggest the need for evidence-based strategies such as outreach support and HIV self-testing to improve HIV testing in this marginalized population.

scholarly journals A Randomized Controlled Trial to Increase HIV Testing Demand Among Female Sex Workers in Kenya Through Announcing the Availability of HIV Self-testing Via Text Message

2018 ◽  
Vol 23 (1) ◽  
pp. 116-125 ◽  
Author(s):  
Elizabeth A. Kelvin ◽  
Gavin George ◽  
Eva Mwai ◽  
Samuel Kinyanjui ◽  
Matthew L. Romo ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Controlled Trial ◽  
Text Message ◽  
Randomized Controlled ◽  
Female Sex ◽  
Self Testing

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Female Sex Workers ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods: We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results: A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

scholarly journals Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049248
Author(s):  
Moses K Kumwenda ◽  
Webster Mavhu ◽  
Wezzie S Lora ◽  
Richard Chilongosi ◽  
Simon Sikwese ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Peer Pressure ◽  
Distribution Model ◽  
Hiv Status ◽  
Female Sex ◽  
Care Services ◽  
Self Testing

ObjectivesHIV testing is the gateway to HIV prevention and care services. Female sex workers (FSW) may benefit from HIV self-testing (HIVST), which offers greater control and confidentiality than other approaches. However, FSW also have unique vulnerabilities, making it critical to understand their perspective of HIVST to best contextualise HIVST to their needs. This study explored feasibility and acceptability of providing oral fluid-based peer-led HIVST to FSW to inform tailored HIVST delivery approaches.DesignQualitative study.SettingMalawi.ParticipantsThirty-nine FSW who had obtained a HIVST kit and eight peer distributors.ResultsPeer distributors’ accounts suggested that peer-led HIVST is feasible. Overall, FSW spoke positively about peer-led HIVST and younger FSW preferred it to facility-based HIV testing. FSW highlighted both greater control of their testing experience and that HIVST could allow them to avoid discriminatory attitudes frequently experienced in public facilities. Some also felt that HIVST kits could enable them to establish the HIV status of their sexual partners, better informing their decisions about condomless sex. Despite overall acceptance of HIVST, a few expressed doubts in the procedure. Some FSW already aware of their HIV-positive status reported using HIVST. A few accounts suggested peer pressure to self-test predominantly from peer distributors.ConclusionsThis study enabled us to explore feasibility and acceptability of peer-led HIVST among FSW, as well as potential shortcomings of the HIV testing modality. Peer distributors are a welcome additional model. However, they should avoid distribution in actual venues. Programmes should ensure a range of testing options are available and expand peer’s representation. Study findings will be used to tailor the HIVST distribution model to ensure its enhanced uptake among key populations in general and FSW, specifically.

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Female Sex Workers ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background: HIV testing is a gateway to HIV care and treatment for those testing positive and can link those with negative results to HIV preventive services. Despite the importance of HIV testing services (HTS) in HIV control, uptake of HTS among female sex workers (FSWs) across sub-Saharan Africa (SSA) remains sub optimal. Concerns about stigma associated with sex work and fear of loss of livelihood if HIV status becomes known, are some of the restrictions for FSWs to utilize HTS offered through health care facilities. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS. This study explored perspectives of FSWs towards HIVST in Tanzania. Methods:We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs in selected regions of Tanzania. Study participants were recruited through snowball sampling. Data were thematically analysed by two analysts using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with the feasibility of scaling up HIVST. Results:A total of 23 PGD sessions were conducted involving 227 FSWs. Data from PGDs were complemented by 21 IDI. FSWs were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality motivated participants’ support for the self-testing approach. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for individuals with reactive test. This was linked to the study participants’ perception that HIVST would be provided only through unassisted modality. Conclusions: FSWs demonstrated high enthusiasm to use the HIVST once it becomes available. Increased confidentiality, reduced opportunity costs, and increased autonomy were among the key factors for the intended use of HIVST. Major concerns included fear of HIV reactive test and not trusting self-diagnoses. Our findings underscore the importance of providing adequate access to counselling and referral services in conjunction with HIVST.

scholarly journals Corrigendum to: A strengths-based analysis of social influences that enhance HIV testing among female sex workers in urban Indonesia

Sexual Health ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. 122
Author(s):  
Kate Whitford ◽  
Elke Mitchell ◽  
Elan Lazuardi ◽  
Emily Rowe ◽  
Irma Anintya Tasya ◽  
...  
Keyword(s):  
Health Services ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Social Influences ◽  
Community Outreach ◽  
Asia Pacific ◽  
Community Based ◽  
Female Sex ◽  
Hiv Prevention Strategies

Background: HIV prevalence among female sex workers in Indonesia remains high and large proportions of female sex workers have never been tested for HIV. International research highlights the importance of community-led strategies to increase HIV testing in this population. Little qualitative research has been conducted to address these issues in Indonesia or other Asia-Pacific countries. This paper documents social influences that enhance HIV testing among female sex workers in urban Indonesia. Methods: This was an interpretive qualitative study in Yogyakarta, Denpasar and Bandung. In total, 57 female sex workers participated in 11 focus group discussions, and four participated in individual semi-structured interviews. Deductive and inductive thematic analysis techniques were used to identify narratives of strengths pertaining to uptake of HIV testing. Results: Participants described supportive relationships with peers, community-based organisations and ‘bosses’. Participants reported trusted networks with peers within which to share information about HIV testing and receive emotional support. Relationships with community outreach workers facilitated HIV testing through reminders, accompanied visits, and emotional/informational support. Community-based organisations worked with health services to facilitate mobile, community-based testing to overcome employment- and family-related constraints that inhibited women’s clinic attendance. ‘Bosses’ employed a variety of practices to encourage HIV testing among their workers. Conclusions: Relationships, practices and action in community- and workplace-based settings outside formal health service spaces enhanced HIV testing among female sex workers. Community- or workplace-based HIV testing with outreach support from health services, peer-led HIV testing within existing social and work-based networks, and working with bosses to implement HIV prevention strategies can address low HIV testing rates in this key population.

scholarly journals Preference and uptake of different community-based HIV testing service delivery models among female sex workers along Malaba-Kampala highway, Uganda, 2017

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gerald Pande ◽  
Lilian Bulage ◽  
Steven Kabwama ◽  
Fred Nsubuga ◽  
Peter Kyambadde ◽  
...  
Keyword(s):  
Service Delivery ◽  
Hiv Testing ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Community Based ◽  
Testing Service ◽  
Service Delivery Models ◽  
Female Sex ◽  
Hiv Testing Services ◽  
Delivery Models

Abstract Introduction Female Sex workers (FSW) and their clients accounted for 18% of the new HIV infections in 2015/2016. Special community-based HIV testing service delivery models (static facilities, outreaches, and peer to peer mechanism) were designed in 2012 under the Most At Risk Populations Frame work and implemented to increase access and utilization of HIV care services for key populations like female sex workers. However, to date there is no study that has been done to access the preference and uptake of different community-based HIV testing service delivery models used to reach FSW. We assessed preference and uptake of the current community-based HIV testing services delivery models that are used to reach FSW and identified challenges faced during the implementation of the models. Methods We conducted a cross-sectional study design using quantitative (interview with the health workers in facilities providing services to female sex workers and interviews with FSWs) and qualitative (interviews with Ministry of Health staff, health workers, district health team members, program staff at different levels involved in delivery of HIV care services, FSWs and political leaders to assess for the enabling environment created to deliver the different community-based HIV testing services to FSWs along the Malaba-Kampala highway. Malaba – Kampala high way is one of the major high ways with many different hot spots where the actual buying and selling of sex takes place. We defined FSWs as any female, who undertakes sexual activity after consenting with a man for money or other items/benefits as an occupation or as a primary source of livelihood irrespective of site of operation within the past six months. We assessed the preference and uptake of different community based HIV testing services delivery model among FSWs based on two indicators, i.e., the proportion of FSWs who had an HIV Counseling and Testing (HCT) in the last 12 months and the proportion of FSWs who were positive and linked to care. Results Overall, 86% (390/456) of the FSWs had taken an HIV test in the last 12 months. Of the 390 FSWs, 72% (279/390) had used static facilities, 25% (98/390) had used outreaches, and 3.3% (13/390) used peer to peer mechanisms to have an HIV test. Overall, 35% (159/390) of the FSWs who had taken an HIV test were HIV positive. Of the 159, 83% (132/159) were successfully linked into care. Ninety one percent (120/132) reported to have been linked into care by static facilities. Challenges experienced included; lack of trust in the results given during outreaches, failure to offer other testing services including hepatitis B and syphilis during outreaches, inconsistent supply of testing kits, condoms, STI drugs, and unfriendly health services due to the infrastructure and non-trained health workers delivering KP HIV testing services. Conclusions Most of the FSWs had HCT services and were linked to care through static facilities. Community-based HIV testing service delivery models are challenged with inconsistent supply of HIV testing commodities and unfriendly services.. We recommended strengthening of all HIV testing community-based HIV testing service deliverymodels by ensuring constant supply of HIV testing/AIDS care commoditiesoffering FSW friendly services, and provision of comprehensive HIV/AIDS health care package.

scholarly journals Female sex workers perspectives and concerns regarding HIV self-testing: An exploratory study in Tanzania

2019 ◽  
Author(s):  
Soori Nnko ◽  
Daniel Nyato ◽  
Evodius Kuringe ◽  
Caterina Casalini ◽  
Amani Shao ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sex Workers ◽  
Exploratory Study ◽  
Risk Perceptions ◽  
Female Sex Workers ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Female Sex ◽  
Self Testing ◽  
Study Participants

Abstract Background HIV testing is a gateway to HIV care and treatment for those testing positive, and can link those with negative reactive tests to HIV preventive services, including enrolment into pre exposure prophylaxis (PrEP). While benefits of HIV testing services (HTS) are known, uptake of HTS among female sex workers (FSWs) in Tanzania and across sub-Saharan Africa (SSA) remains suboptimal. Introduction of HIV self-testing (HIVST) may mitigate some of the barriers for the uptake of HTS, and contribute to greater linkage to care and prevention services. This study explored perspectives of FSWs towards HIVST, to inform a large-scale combination HIV prevention program addressing key populations (KPs) in Tanzania. Methods We conducted an exploratory study employing in-depth interviews (IDI) and participatory group discussions (PGD) with FSWs. PGD collected normative data e.g. perceptions and attitudes towards HTS, whereas IDI collected personal information e.g. sexual practices and HIV risk perceptions. Study participants were recruited through snowball sampling. Data were thematically analysed using NVivo software. Emerging themes were explored in the tradition of Grounded Theory. The analysis was informed by the social ecological model and focused on factors associated with feasibility of scale up of HIVST. Results A total of 20 PGD sessions were conducted involving 227 participants. We also conducted IDIs with 21 FSWs. Study participants were enthusiastic toward HIVST. Convenience (time and cost saved), and belief that HIVST will increase privacy and confidentiality were primary in participants’ support for the HIVST. Participants did express concerns about their ability to interpret and trust the results of the test. Participants also expressed concern that HIVST could cause personal harm, including severe distress and self-harm for the FSWs with reactive test – this was related to the lack of professional counselling support in the self-testing environment. Conclusions Increased confidentiality, reduced cost for care, and increased autonomy were among the leading motivations to use HIVST. Major concerns included fear of HIV positive results, and not trusting self-diagnoses. We underscore the importance of providing adequate support services in conjunction with HIVST, e.g. access to counselling and referral services, and user-accessible support to the interpretations of test results.

scholarly journals Correlates of HIV self-testing among female sex workers in China: implications for expanding HIV screening

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Cheng Wang ◽  
Ya-Jie Wang ◽  
Joseph D. Tucker ◽  
Ming-Zhou Xiong ◽  
Hong-Yun Fu ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Sexually Transmitted Infections ◽  
Sexual Behaviors ◽  
Sex Workers ◽  
Female Sex Workers ◽  
Sexually Transmitted ◽  
The Past ◽  
Female Sex ◽  
Self Testing ◽  
Hiv Test

Abstract Background Human immunodeficiency virus (HIV) self-testing may help improve test uptake among female sex workers. China has implemented many HIV self-testing programs among men who have sex with men, creating an opportunity for promotion among female sex workers. However, there is a limited literature on examining HIV self-testing among female sex workers. This study aimed to examine HIV self-testing experiences and its determinants among female sex workers in China. Methods A venue-based, cross-sectional study was conducted among Chinese female sex workers in 2019. Participants completed a survey including social-demographic characteristics, sexual behaviors, and HIV self-testing history, the distribution of which were analyzed using descriptive analysis. Multivariable logistic regression was conducted to identify associations with HIV self-testing. Results Among 1287 Chinese female sex workers, 1072 (83.3%, 95% confidence interval [CI] 81.2–85.3%) had ever tested for HIV, and 103 (8.0%, 95% CI 6.6–9.6%) had ever used HIV self-testing. More than half reported that the self-test was their first HIV test (59.2%, 61/103), around one-fifth reported HIV self-testing results influenced the price of sex (21.4%, 22/103). A minority of individuals reported ever experiencing pressure to undertake HIV self-testing (6.8%, 7/103). After adjusting for covariates, HIV self-testing was positively associated with receiving anal sex in the past month (adjusted odds ratio [aOR] = 2.2, 95% CI 1.4–3.5), using drugs before or during sex (aOR = 2.8, 95% CI 1.8–4.5), injecting drugs in the past 6 months (aOR = 2.6, 95% CI 1.2–6.0), being diagnosed with other sexually transmitted infections (aOR = 1.6, 95% CI 1.0–2.5), tested for other sexually transmitted infections in the past six months (aOR = 3.4, 95% CI 2.1–5.5), ever tested in the hospital (aOR = 3.4, 95% CI 2.0–5.6), and ever tested in the community (aOR = 1.5, 95% CI 1.2–1.9). Conclusions Our findings suggest that HIV self-testing could expand overall HIV testing uptake, increase HIV testing frequency, reach sub-groups of high-risk female sex workers and has limited potential harms among female sex workers. HIV self-testing should be incorporated among Chinese female sex workers as a complement to facility-based HIV testing services.

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