UNITAID PSI HIV SELF-TESTING AFRICA Feasibility of HIV self-test programming among female sex workers in Zimbabwe Sue Napierala Mavedzenge, RTI International UNITAID PSI HIV SELF-TESTING AFRICA

Background FSW are disproportionately affected by HIV Engagement in HIV services does not reflect heightened risk Increasing HIV testing is the first step towards prevention and care services Cowen, F.M. et al., 2017

Background Little research on HIVST among FSW, which may be particularly appropriate for this population Supervised self-testing among 40 FSW using instructions validated among a general population demonstrated excellent accuracy Napierala Mavedzenge et al., unpublished data

Methodology We offered HIVST for 6 months at a dedicated FSW clinic in Zimbabwe FSW presenting for testing were given the option of provider delivered testing or HIVST Participants received self-test kits and validated instructions They were contacted after 2 weeks to complete a questionnaire about their experience

Results: HIVST uptake and use 607 FSW presented for testing and 325 (54%) opted for HIVST (p=0.10) 100% used the self-test 313 (96%) tested at the clinic site 4 (1%) tested with someone else present 100% reported the self-test was not at all hard to use

Baseline characteristics of those opting to self-test (N=325)

HIVST results and linkage

Acceptability of HIVST among FSW

Willingness of FSW to pay for HIV self-test (n=325)

Qualitative Results FSW concerns about making HIVST available 38% thought forced testing was possible FSW thought HIVST promotion should be via mass media; pamphlets/posters at beerhalls & clinics; PE & outreach FSW thought HIVST distribution should be via clinic (62%), pharmacy (18%), peer (14%) and/or workplace (13%).

Next steps HIVST distribution now at 6 dedicated FSW clinics, and 12 outreach sites Preparing to begin community distribution FSW may take additional test kits for partners FGD among FSW indicate that we are still not reaching those who do not attend clinic services (WEPDD0102)

Conclusions FSW found HIVST highly acceptable, wanted HIVST to be available, expressed willingness to pay for kits A high proportion of FSW had reactive self-test; virtually all linked to posttest services by 2 week follow-up Some concern expressed around HIVST scale-up, along with suggestions for mediation FSW provided useful insight into how to distribute and promote HIVST HIVST represents a promising strategy to promote regular retesting among FSW in Zimbabwe

Acknowledgements Thank you! FSW in Zimbabwe for their participation Co-authors Frances Cowan Euphemia Sibanda Karin Hatzold Jeffrey Dirawo Owen Mugurungi For their generous financial support RTI International DfID UNITAID Thank you!