Background: Female sex workers (FSW) are disproportionately affected by HIV, yet their engagement in HIV services does not reflect this heightened risk. Increasing HIV testing is the first step towards prevention and care services. There is little research on HIV self-testing (HIVST) among FSW, which may be particularly appropriate for this population. We conducted a pilot study offering HIVST for 6 months to FSW in Zimbabwe to evaluate programmatic feasibility.
Methods: Adult FSW of unknown HIV status presenting for testing at a dedicated FSW clinic were given the option of provider-delivered testing or HIVST. Those opting for HIVST and who had a mobile phone were invited to enroll. Participants received self-test kits and validated instructions. They were contacted after 2 weeks to complete a questionnaire about their experience.
Results: 607 FSW presented for testing and 325 (54%) opted for HIVST (p< 0.01). Among self-testers, mean age was 29 years (range 18-62). Most (94%) had previously tested for HIV. 100% reported the test was not difficult to use, and 98% were comfortable learning their result without a provider present. 30% had a reactive result, and of those, 99% had attended post-test services by the 2-week post-test questionnaire. 100% indicated they would want HIVST to be available to them, and would recommend HIVST to family/friends. 81% would recommend HIVST to their clients. Though no participants were forced to self-test, 38% thought coercive testing might happen if HIVST became more widely available. FSW thought HIVST distribution should be via clinic (62%), pharmacy (18%), peer (14%) and/or workplace (13%). FSW indicated they would be willing to pay $0.50-$25 for self-tests, with 35% willing to pay $1 and 30% $5.
Conclusions: FSW found HIVST highly acceptable, and wanted HIVST to be available to them. A high proportion had a reactive self-test, and importantly, virtually everyone had linked to post-test services by the 2-week follow-up questionnaire. Some expressed concern about potential for coercive testing. FSW were willing to pay for HIVST, and provided useful insight into how to distribute and promote HIVST during future implementation research. HIVST represents a promising strategy to promote regular re-testing among FSW in Zimbabwe.