News @ JSI

JSI’s Research Published in Innovative HIV Self-Testing Study

April 26, 2017

Female sex workers (FSWs) carry a disproportionate burden of the HIV epidemic globally. Discrimination and stigma, both internal and external, often prevent the women from going to a clinic or connecting with a healthcare provider to be tested for HIV.

In order to evaluate innovative solutions to this problem, JSI and Harvard University’s T.H. Chan School of Public Health began a research initiative in Zambia on HIV self-testing (HIVST) as an alternative method of initiating HIV testing for FSWs.

The research, recently published by BMJ Open, titled Zambian Peer Educators for HIV Self-Testing (ZEST) study rationale and design of a cluster randomised trial of HIV self-testing among female sex workers in Zambia, is one of the first peer-reviewed publications to evaluate the effectiveness and safety of HIVST among FSWs.

“This is groundbreaking work in that the barriers which have been preventing FSWs from testing for HIV regularly, including real and perceived stigma from some counsellors in clinics towards FSWs, fear of a blood based test, distance, and opportunity costs that come with the precious time of FSWs, have all been overcome in this one breakthrough,” said Dr. Michael Chanda, the publication’s co-author and deputy project director of the JSI-implemented USAID DISCOVER-Health Project.

The publication, a product of more than a year’s worth of research, is the first of several upcoming articles based on data gathered during the ZEST study. It details the study’s overall structure, an innovative approach to distribution with a third arm offering the standard practice of referring a cohort of FSWs to traditional testing mechanisms at the clinics serving as the control. The study employs two different distribution approaches (direct and fixed) for HIV self-test kits with the goal of increasing HIV testing coverage among FSWs, improving HIV status knowledge among FSWs, measuring HIVST use, and determining effective links to existing HIV care.

As part of this process, the study engaged 160 peer educators, each of whom had the goal of connecting with six active FSWs in three border and transit towns in Zambia: Chirundu, Livingstone, and Kapiri Mposhi.

“They are the agent of action here. The sex workers distribute the test kits or coupons to pick up a test kit directly to other sex workers,” said Andrew Fullem, the publication’s co-author and the director of JSI’s HIV and Infectious Diseases Center.  “It’s about engaging the community and helping to give greater stature to peer navigators who also come from the community.”

The FSWs in all the three study sites are willing to continue distributing HIVST kits and mobilizing their peers. They also proposed extending this distribution to their regular sexual partners. “We are ready to mobilize even more of our friends to also test so that they know their status. Even our boyfriends, we can convince them to test. Another thing we can do is to also ask our men to go for circumcision because these things must be moving together,” one peer educator said in Chirundu during the closeout meeting.

Read the study here.

Learn more about JSI's innovative HIV programming.