1. HIV Self-Testing among Female Sex Workers in Zambia: A Randomized Controlled Trial
Michael M. Chanda, Katrina F. Ortblad, Magdalene Mwale,
Steven Chongo, Catherine Kanchele, Nyambe Kamungoma,
Andrew Fullem, Caitlin Dunn, Leah G. Barresi, Guy Harling,
Till Bärnighausen, Catherine E. Oldenburg

2. Disclosures
None to report

3. HIV Self-Testing among Female Sex Workers
2016 WHO guidelines recommend HIV self-testing be offered in addition to standard testing services
May help address multilevel barriers to testing for female sex workers
Development of effective delivery approaches essential

4. Zambian Peer Educators for HIV Self-Testing (ZEST) Study
160 Peer Educators (PEs)
Each PE Recruits 6 FSW
Randomization
Standard of Care
Condoms
HIV, IPV counseling
Referral to standard HIV testing
Access to 24/7 hotline with counselors
Direct Delivery
Standard of care plus:
Oral HIVST demonstration
HIVST kit distribution (at baseline and 3 mo)
Coupon Distribution
Standard of care plus:
Oral HIVST kit demonstration
HIVST kit coupon redeemable at local drug stores (at baseline and 3 mo)

5. ZEST Study Sites
Livingstone
Kapiri Mposhi
Chirundu

6. Inclusion Criteria 18 years of age or older
Exchanged sex at least once for money/goods in past month
Self-reported HIV negative or unknown status
No recent (<3 months) HIV test
Primary residence in Livingstone, Kapiri Mposhi, or Chirundu

7. Assessments
Participants completed questionnaires at baseline, 1, and 4 months
Primary outcome: Past one-month HIV testing at one month
Secondary outcomes
Past one-month HIV testing at four months
HIV self-test use
Linkage to care and ART initiation
Adverse events

8. Enrollment and Follow-Up
Phone Screening
N=1,280
Assessed for Eligibility
N=992
Randomized
N=965
Standard of Care
N=320
Direct Delivery
N=316
Coupon
N=329
One Month
N=296
One Month
N=296
One Month
N=294
91.8%
Four Months
N=301
Four Months
N=295
Four Months
N=302
93.1%

9. Baseline Characteristics
Standard Testing
(N=320)
HIVST Distribution (Delivery)
(N=322)
HIVST Coupon Distribution
(N=323)
Age (median, IQR)
25 (22 to 31)
25 (21 to 30)
Site
Livingstone
Kapiri
Chirundu
156 (48.8%)
87 (27.2%)
77 (24.1%)
162 (51.3%)
76 (24.1%)
78 (24.7%)
162 (49.2%)
82 (24.9%)
85 (25.8%)
Primary education or higher
267 (83.4%)
292 (90.7%)
295 (92.3%)
HIV test, past 12 mo
200 (62.5%)
189 (58.7%)
228 (70.6%)
IPV, past 12 mo
196 (61.4%)
194 (61.4%)
199 (60.5%)

10. Past One-Month HIV Testing
95%
89%
84%
84%
80%
75%
One Month
Four Months

11. Risk Ratios: Past One-Month HIV Testing
RR=1.11
RR=1.13
RR=1.06
RR=1.07
RR=1.05
RR=0.95
One Month
Four Months

12. HIV Self-Test Kit Use Used: 98% vs 86%; P=0.001
One Month
Four Months
Used: 98% vs 86%; P=0.001
Used: 90% vs 89%; P=0.88

13. Linkage to Care and ART Uptake*
*Among participants reporting a positive most recent test

14. Adverse Events
Three reports of intimate partner violence related to HIV self-testing
No reports of test misuse, coercive testing, accidental or unauthorized disclosure of HIV status, or psychosocial distress

15. Limitations Overall HIV testing very high Self-reported outcomes
Participants followed for only 4 months

16. Summary
HIV self-testing was highly used by participants, but did not increase HIV testing rates relative to standard of care
Facility-based delivery is acceptable and used by participants, but may lead to slower roll-out
HIV self-testing did not lead to elevated rates of intimate partner violence

17. Conclusions
HIV self-testing is acceptable, accessible, and safe for FSW in Zambia
Uptake of HIV self-testing may be slower with facility-based delivery
Linkage to care may be delayed following HIV self-testing

18. Thank you! Michael M. Chanda Katrina F. Ortblad Magdalene Mwale
Steven Chongo
Catherine Kanchele
Nyambe Kamungoma
Andrew Fullem
Caitlin Dunn
Leah G. Barresi
Guy Harling
Till Bärnighausen
ZEST research assistants
International Initiative for Impact Evaluation (3ie)