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

Kumwenda, Moses, Mavhu, Webster ORCID: https://orcid.org/0000-0003-1881-4398, Lora, Wezzie S., Chilongosi, Richard, Sikwese, Simon, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Hatzold, Karin, Johnson, Cheryl C., Corbett, Elizabeth L. and Desmond, Nicola ORCID: https://orcid.org/0000-0002-2874-8569 (2021) 'Feasibility and acceptability of a peer-led HIV self-testing model among female sex workers in Malawi: a qualitative study'. BMJ Open, Vol 11, Issue 12, e049248.

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Abstract

Objectives: HIV 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.

Design: Qualitative study.

Setting: Malawi.

Participants: Thirty-nine FSW who had obtained a HIVST kit and eight peer distributors.

Results: Peer 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 unprotected 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 tacit “coercion” to self-test predominantly from peer distributors and venue owners . At time of interviews, only a few HIV-positive FSW had accessed treatment.

Conclusions: This 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.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 309 Women's health WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Sexually Transmitted Diseases > WC 140 Sexually transmitted diseases WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjopen-2021-049248
Depositing User:	Rachel Dominguez
Date Deposited:	04 Jan 2022 15:04
Last Modified:	04 Jan 2022 15:04
URI:	https://archive.lstmed.ac.uk/id/eprint/19576

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