UNITAID PSI HIV SELF-TESTING AFRICA WHEN THE RUBBER MEETS THE ROAD: Moving Self-Testing from a Theory to a Reality for Africa DESIGNING SAFE, ACCEPTABLE AND APPROPRIATE HIVST INTERVENTIONS FOR FEMALE SEX WORKERS Frances Cowan, University College London, CeSHHAR Zimbabwe

Acknowledging  Sue Mavedzenge  Euphemia Sibanda

Outline  What we know already  Preliminary work on HIV ST among sex workers from Zimbabwe  Worked planned to establish delivery models for HIV ST for FSW  Zimbabwe  Malawi

FSW in sub Saharan Africa  FSW bear a disproportionate burden of HIV in SSA  Studies from Malawi, South Africa and Malawi showing poor linkage to prevention and care services  Community based sex worker led empowerment based programmes do increase engagement with services

SAPPH-IRe trial in Zimbabwe Baseline survey sites n=2, % of HIV + FSW aware of status Endline survey sites N=2, % of HIV + FSW aware of status

Few studies among FSW relating to HIVST  No studies identified exploring attitudes and acceptability  Two studies looking at community based HTC for FSW but not ST (neither in SSA)  No studies identified distributing HIV ST to FSW for their own use

SAPPH-IRe trial at baseline 2013 (n=2722) Very interested Somewhat interested Not at all interested If a simple-to-use home HIV test were available to you, how interested would you be in testing yourself for HIV, i.e. HIV self-testing? 67.2%8.4%24.4% YesNoMaybe If HIV self-testing were available to you, do you think you would test for HIV more frequently? 72.4%19.1%8.4% If a simple-to-use home HIV had been available to you before you knew your status, i.e. a HIV self-test, would you have preferred to test yourself rather than have been tested by a health care worker? 53.6% 46.4%

One study where FSW used to distribute tests to sex partners

Formative work completed in Zimbabwe PI Mavedzenge

Supervised self-testing among Zimbabwean female sex workers  Supervised self-testing among 40 FSW using instructions validated among a general population

Observational study Aim: To evaluate acceptability and feasibility of HIVST among FSW  Choice of HIVST or provider-testing offered over 6 months to clients of unknown HIV status at a dedicated FSW clinic  Those opting to self-test completed a pre-test questionnaire  Provided with a HIVST kit and validated instructions  Contacted after 2 weeks by telephone to complete a post-test questionnaire

Results  607 clients tested  325 (54%) opted to self-test (p<0.01)

Results (among 325 who self-tested)

Planned FSW work within STAR in Zimbabwe  Using qualitative research methods, conduct formative work to determine how to undertake community delivery of HIV self-test among sex workers  Based on findings in Aim 1, implement and evaluate the cost-effectiveness of the self-test demonstration projects in terms of testing uptake and HIV case diagnosis and linkage  Using data from Aims 1 and 2, determine which strategies should be scaled up, and what if any modifications are required to effectively do so.

Study participants  Sex workers engaged in Sisters with a Voice – Zimbabwe’s National Sex Work Program in Harare and Bulawayo  Sex workers identified through hair salons in Harare and Bulawayo

STAR Malawi: Monitoring social harms following peer-led delivery of HIV self-testing to key populations  Objective  Investigate appropriate HIVST delivery models among FSWs and MSM and monitor unintended social consequences and human rights impacts from introducing HIVST to FSWs  Implementation research around peer-led HIVST distribution by PSI-contracted Pakachere  Study location – Mulanje and Zomba  Study period – July 2016 to January 2017

CINs Peer-led HIVST delivery REAs ACASI n=204 SBI n=20 ACASI n=204 SBI n=20 FGDs REA - Rapid Ethnographic Assessment ACASI – Audio Computer Assisted Survey Instrument SBI - Serial Biographical Interviews FGD - Focus Group Discussion

In summary  FSW are able to test themselves accurately  Over 50% of FSW in one study opted for HIV ST over PITC in one Zimbabwean study  There is a dearth of information about the best models for community delivery HIV ST in FSW in SSA and any associated social harms  Peer educators / hairdressers / mobile outreach

Contact DR. KARIN HATZOLD Director UNITAID/PSI HIV Self-Testing Africa (STAR) Project