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Open Access 01-05-2019 | Human Immunodeficiency Virus | Original Paper

The Effect of HIV Self-Testing Delivery Models on Female Sex Workers’ Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda

Authors: Katrina F. Ortblad, Daniel Kibuuka Musoke, Thomson Ngabirano, Aidah Nakitende, Guy Harling, Jessica E. Haberer, Margaret McConnell, Joshua A. Salomon, Catherine E. Oldenburg, Till Bärnighausen

Published in: AIDS and Behavior | Issue 5/2019

Abstract

HIV self-testing increases recent and frequent HIV testing among female sex workers (FSWs) in urban Uganda. Using results from a randomized controlled trial, we aim to establish the effect of HIV self-testing delivery models on FSWs’ sexual behaviors in this setting. Clusters of one peer educator and eight participants were 1:1:1 randomized to: (1) direct provision of an HIV self-test, (2) provision of a coupon for facility collection of an HIV self-test, or (3) referral to standard-of-care HIV testing services. Sexual behaviors were self-reported at 1 and 4 months. From October to November 2016, 960 participants were enrolled and randomized. At 4 months, there were no statistically significant differences in participants’ sexual behaviors, including inconsistent condom use, across study arms. We do not find any changes in sexual risk-taking among FSWs in response to the delivery of HIV self-tests. Routine policies for HIV self-testing are likely a behaviorally safe component of comprehensive HIV prevention strategies.

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Masters SH, Agot K, Obonyo B, Mavedzenge SN, Maman S, Thirumurthy H. Promoting partner testing and couples testing through secondary distribution of HIV self-tests: a randomized clinical trial. PLOS Med. 2016;13(11):e1002166.CrossRefPubMedPubMedCentral

Thirumurthy H, Masters SH, Mavedzenge SN, Maman S, Omanga E, Agot K. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV. 2016;3(6):e266–74.CrossRefPubMedPubMedCentral

Wang Z, Lau JTF, Ip M, Ho SPY, Mo PKH, Latkin C, et al. A randomized controlled trial evaluating efficacy of promoting a home-based HIV self-testing with online counseling on increasing HIV testing among men who have sex with men. AIDS Behav. 2017. https://doi.org/10.1007/s10461-017-1887-2.CrossRefPubMedPubMedCentral

Katz D, Golden M, Hughes J, Farquhar. HIV self-testing increases HIV testing frequency among high-risk men who have sex with men: a randomized controlled trial. In: 8th Conference on HIV pathogenesis, treatment and prevention, 19–22 July 2015, Vancouver, Canada; 2015.

Jamil MS, Prestage G, Fairley CK, Grulich AE, Smith KS, Chen M, et al. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. Lancet HIV. 2017;4(6):e241–50.CrossRefPubMed

Chanda M, Ortblad K, Mwale M, Chongo S, Kanchele C, Kamungoma N, et al. HIV self-testing among female sex workers in Zambia: a cluster randomized controlled trial. PLOS Med. 2017;14(11):e1002442.CrossRefPubMedPubMedCentral

Ortblad K, Kibuuka Musoke D, Ngabirano T, Nakidende A, Magoola J, Kayiira P, et al. Direct provision versus facility collection of HIV self-tests among female sex workers in Uganda: a cluster-randomized controlled health systems trial. PLOS Med. 2017;14(11):e1002458.CrossRefPubMedPubMedCentral

Ayles H, Floyd S, Mulubwa C, Hensen B, Schaap A, Phiri B, et al. Increasing knowledge of HIV status among men: a cluster-randomised trial of community-based distribution of oral HIV self-test kits nested in four HPTN 071 communities in Zambia. In: 9th IAS conference on HIV science, 23–26 July 2017, Paris, France; 2017.

Gichangi A, Wambua J, Gohole A, Mutwiwa S, Njogu R, Bazant E. Provision of oral HIV self-test kits triples uptake of HIV testing among male partners of antenatal care clients: results of a randomized trial in Kenya. In: 21st International AIDS conference, 18–22 July 2016, Durban, South Africa; 2016.

10.

Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. J Int AIDS Soc. 2017. https://doi.org/10.7448/IAS.20.1.21594.CrossRefPubMedPubMedCentral

11.

WHO. Consolidated guidelines on HIV testing services; 5Cs: consent, confidentiality, counseling, correct results and connection. Geneva: WHO; 2015. http://apps.who.int/iris/bitstream/10665/179870/1/9789241508926_eng.pdf.

12.

Wanyenze RK, Musinguzi G, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J, et al. “When they know that you are a sex worker, you will be the last person to be treated”: perceptions and experiences of female sex workers in accessing HIV services in Uganda. BMC Int Health Hum Rights. 2017;17(1):11.CrossRefPubMedPubMedCentral

13.

Chanda M, Perez-Brumer A, Ortblad K, Mwale M, Chongo S, Kamungoma N, et al. Barriers and facilitators to HIV testing among Zambia female sex workers in three transit hubs. AIDS Patient Care STDs. 2017;31(7):290–6.CrossRefPubMedPubMedCentral

14.

Lancaster KE, Cernigliaro D, Zulliger R, Fleming PF. HIV care and treatment experiences among female sex workers living with HIV in sub-Saharan Africa: a systematic review. Afr J AIDS Res. 2016;15(4):377–86.CrossRefPubMedPubMedCentral

15.

Lafort Y, Lessitala F, Candrinho B, Greener L, Greener R, Beksinska M, et al. Barriers to HIV and sexual and reproductive health care for female sex workers in Tete, Mozambique: results from a cross-sectional survey and focus group discussions. BMC Public Health. 2016;16:608.CrossRefPubMedPubMedCentral

16.

UNAIDS. The gap report. Geneva: UNAIDS; 2014. http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Gap_report_en.pdf.

17.

Balán IC, Carballo-Diéguez A, Frasca T, Dolezal C, Ibitoye M. The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men. AIDS Behav. 2014;18(2):254–62.CrossRefPubMedPubMedCentral

18.

Frasca T, Balan I, Ibitoye M, Valladares J, Dolezal C, Carballo-Diéguez A. Attitude and behavior changes among gay and bisexual men after use of rapid home HIV tests to screen sexual partners. AIDS Behav. 2014;18(5):950–7.CrossRefPubMedPubMedCentral

19.

Oldenburg C, Chanda M, Ortblad K, Mwale M, Chongo S, Kamungoma N, et al. Effect of HIV self-testing on the number of partners among female sex workers in Zambia: a randomized controlled trial. AIDS. 2017;32(5):645–52.

20.

Blanchard AK, Mohan HL, Shahmanesh M, Prakash R, Isac S, Ramesh BM, et al. Community mobilization, empowerment and HIV prevention among female sex workers in South India. BMC Public Health. 2013;13:234.CrossRefPubMedPubMedCentral

21.

Beattie TSH, Mohan HL, Bhattacharjee P, Chandrashekar S, Isac S, Wheeler T, et al. Community mobilization and empowerment of female sex workers in Karnataka State, South India: associations with HIV and sexually transmitted infection risk. Am J Public Health. 2014;104(8):1516–25.CrossRefPubMedPubMedCentral

22.

UNAIDS. Ending AIDS: progress towards the 90–90–90 targets. Geneva: UNAIDS; 2017 (cited 1 Aug 2017). http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf.

23.

HIVST.org. Policy and regulations for HIVST. HIVST.org (cited 8 Sep 2015). http://www.hivst.org/policy-regulations-for-hivst-1/.

24.

WHO. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: WHO; 2016 (cited 12 June 2018). http://apps.who.int/iris/bitstream/10665/246200/1/9789241511124-eng.pdf.

25.

ClinicalTrials.gov. Impact of HIV self-testing among female sex workers in Kampala, Uganda (HSPOT). ClinicalTrials.gov; 2016. https://clinicaltrials.gov/ct2/show/NCT02846402.

26.

Closson K, Dietrich JJ, Lachowsky NJ, Nkala B, Palmer A, Cui Z, et al. Gender, sexual self-efficacy and consistent condom use among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa. AIDS Behav. 2017;22(2):671–80.CrossRef

27.

Hong Y, Li X, Fang X, Zhao R. Depressive symptoms and condom use with clients among female sex workers in China. Sex Health. 2007;4(2):99–104.CrossRefPubMedPubMedCentral

28.

Bachanas P, Medley A, Pals S, Kidder D, Antelman G, Benech I, et al. Disclosure, knowledge of partner status, and condom use among HIV-positive patients attending clinical care in Tanzania, Kenya, and Namibia. AIDS Patient Care STDs. 2013;27(7):425–35.CrossRefPubMedPubMedCentral

29.

Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa. Sex Transm Infect. 2007;83(1):29–34.CrossRefPubMed

30.

Delavande A, Kohler H-P. The impact of HIV testing on subjective expectations and risky behavior in Malawi. Demography. 2012;49(3):1011–36.CrossRefPubMed

31.

Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. Am J Public Health. 1999;89(9):1397–405.CrossRefPubMedPubMedCentral

32.

Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20(10):1447–50.CrossRefPubMed

33.

Gong E. HIV testing and risky sexual behaviour. Econ J. 2015;125(582):32–60.CrossRef

34.

Haile B. Promoting HIV testing and safe sexual behavior: evidence from a field experiment in Ethiopia. Department of Economics, Columbia University; 2011. https://www.csae.ox.ac.uk/conferences/2011-EdiA/papers/390-Haile.pdf.

35.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16(9):606–13.CrossRefPubMedPubMedCentral

36.

Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. Can Med Assoc J. 2012;184(3):E191–6.CrossRef

37.

Montori VM, Guyatt GH. Intention-to-treat principle. Can Med Assoc J. 2001;165(10):1339–41.

38.

Gupta SK. Intention-to-treat concept: a review. Perspect Clin Res. 2011;2(3):109–12.CrossRefPubMedPubMedCentral

39.

Ranganathan P, Pramesh CS, Aggarwal R. Common pitfalls in statistical analysis: intention-to-treat versus per-protocol analysis. Perspect Clin Res. 2016;7(3):144–6.CrossRefPubMedPubMedCentral

40.

Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.CrossRefPubMed

41.

Stevens DR, Vrana CJ, Dlin RE, Korte JE. A global review of HIV self-testing: themes and implications. AIDS Behav. 2018;22(2):497–512.CrossRefPubMedPubMedCentral

42.

Wright AA, Katz IT. Home testing for HIV. N Engl J Med. 2006;354(5):437–40.CrossRefPubMed

43.

Walensky RP, Paltiel AD. Rapid HIV testing at home: does it solve a problem or create one? Ann Intern Med. 2006;145(6):459–62.CrossRefPubMed

44.

Horvath KJ, Oakes JM, Rosser BRS. Sexual negotiation and HIV serodisclosure among men who have sex with men with their online and offline partners. J Urban Health Bull N Y Acad Med. 2008;85(5):744–58.CrossRef

45.

Aghaizu A, Wayal S, Nardone A, Parsons V, Copas A, Mercey D, et al. Sexual behaviours, HIV testing, and the proportion of men at risk of transmitting and acquiring HIV in London, UK, 2000–13: a serial cross-sectional study. Lancet HIV. 2016;3(9):e431–40.CrossRefPubMed

46.

Campbell C. Selling sex in the time of AIDS: the psycho-social context of condom use by sex workers on a Southern African mine. Soc Sci Med 1982. 2000;50(4):479–94.

47.

Karim QA, Karim SS, Soldan K, Zondi M. Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers. Am J Public Health. 1995;85(11):1521–5.CrossRefPubMedPubMedCentral

48.

Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538–49.CrossRefPubMed

49.

Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2015;385(9962):55–71.CrossRefPubMed

50.

CDC. Crane survey: select results from recent surveys, Kampala 2012/3. Kampala (cited 28 March 2017). http://documentslide.com/documents/crane-survey-select-results-from-recent-surveys-kampala-20123-men-who-have.html.

51.

Ortblad K, Kibuuka Musoke D, Ngabirano T, Nakitende A, Haberer JE, McConnell M, et al. Female sex workers often incorrectly interpret HIV self-test results in Uganda. JAIDS. 2018;79(1):e42–5.PubMed

52.

Corno L, de Paula A. Risky sexual behaviors: biological markers and self-reported data. CEPR Discuss Paper No. DP10271. http://www.ucl.ac.uk/~uctpand/cornodepaula_201707.pdf.

53.

Gallo MF, Steiner MJ, Hobbs MM, Warner L, Jamieson DJ, Macaluso M. Biological markers of sexual activity: tools for improving measurement in HIV/sexually transmitted infection prevention research. Sex Transm Dis. 2013. https://doi.org/10.1097/OLQ.0b013e31828b2f77.CrossRefPubMedPubMedCentral

Title: The Effect of HIV Self-Testing Delivery Models on Female Sex Workers’ Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda
Authors: Katrina F. Ortblad
Daniel Kibuuka Musoke
Thomson Ngabirano
Aidah Nakitende
Guy Harling
Jessica E. Haberer
Margaret McConnell
Joshua A. Salomon
Catherine E. Oldenburg
Till Bärnighausen
Publication date: 01-05-2019
Publisher: Springer US
Keyword: Human Immunodeficiency Virus
Published in: AIDS and Behavior / Issue 5/2019
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-019-02393-z

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