HIV self-testing services for female sex workers, Malawi and Zimbabwe

Napierala, S, Desmond, Nicola ORCID: https://orcid.org/0000-0002-2874-8569, Kumwenda, Moses, Tumushime, Mary, Sibanda, Euphemia ORCID: https://orcid.org/0000-0003-1754-1076, Indravudh, P, Hatzold, K, Johnson, C, Baggaley, R, Corbett, E and Cowan, Frances ORCID: https://orcid.org/0000-0003-3087-4422 (2019) 'HIV self-testing services for female sex workers, Malawi and Zimbabwe'. Bulletin of the World Health Organization, Vol 97, Issue 11, pp. 764-776.

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Abstract

Objective
To present findings from implementation and scale-up of human immunodeficiency virus (HIV) self-testing programmes for female sex workers in Malawi and Zimbabwe, 2013–2018.
Methods In Zimbabwe, we carried out formative research to assess the acceptability and accuracy of HIV self-testing. During implementation we evaluated sex workers’ preferences for and feasibility of distribution of test kits before the programme was scaled-up. In Malawi, we conducted a rapid ethnographic assessment to explore the context and needs of female sex workers and resources available, leading to a workshop to define the distribution approach for test kits. Once distribution was implemented, we conducted a process evaluation and established a system for monitoring social harm.
Findings In Zimbabwe, female sex workers were able to accurately self-test. The preference study helped to refine systems for national scale-up through existing services for female sex workers. The qualitative data helped to identify additional distribution strategies and mediate potential social harm to women. In Malawi, peer distribution of test kits was the preferred strategy. We identified some incidents of social harm among peer distributors and female sex workers, as well as supply-side barriers to implementation which hindered uptake of testing.

Conclusion Involving female sex workers in planning and ongoing implementation of HIV self-testing is essential, along with strategies to mitigate potential harm. Optimal strategies for distribution and post-test support are context-specific and need to consider existing support for female sex workers and levels of trust and cohesion within their communities.

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 > 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/10.2471/BLT.18.223560
Depositing User:	Rachel Dominguez
Date Deposited:	10 Sep 2019 10:44
Last Modified:	29 Jan 2021 12:59
URI:	https://archive.lstmed.ac.uk/id/eprint/11123

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