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      Acceptability of oral HIV self-testing among female sex workers in Gaborone, Botswana

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          Abstract

          Background

          HIV prevalence among female sex workers (FSW) in sub-Saharan Africa is much higher than in the general population. HIV self-testing (HIVST) may be useful for increasing testing rates in FSW.

          Methods

          We conducted semi-structured in-depth interviews among FSW, nurses and lay counsellors providing services to FSWs in Botswana. We aimed to gain understanding of perceived acceptability, anticipated barriers, and preferred approaches to HIVST among FSW. Interviews were audio-recorded, transcribed and translated. Transcripts were reviewed and coded independently by two investigators; high inter-coder agreement was achieved (Kappa = 0.80).

          Results

          We interviewed five care providers whose average age was 40 years (SD = 2,64, range = 37–43); three nurses and two counsellors. Thirty FSW were interviewed, with mean age 34 years (range = 20–52). Most (27; 90%) FSW expressed great interest in using HIVST kits. Facilitators of HIVST were: awareness of own risky sexual behaviours, desire to stay healthy, and perceived autonomy over one’s healthcare decisions. Perceived advantages of HIVST included convenience, privacy, and perception of decreased stigma. Identified barriers to HIVST included lack of knowledge about the HIVST kit, fear of testing due to anticipated stigma, mistrust of the test’s accuracy, doubt of self-competency to perform HIVST, and concerns about not linking to care. Assisting someone to test was noted as good for providing emotional support, but there were concerns about confidentiality breaches. Providers expressed concerns over low literacy among FSWs which could affect comprehension of testing instructions, and competency to perform testing and interpret results. Participants’ recommendations for implementation of HIVST included: ensuring wide dissemination of information on HIVST, engaging peers in information-sharing and education, making test kits accessible in FSW-friendly centres, and having clear instructions for linkage to healthcare and support.

          Conclusion

          HIVST shows high acceptability among FSWs in Gaborone Botswana, with providers expressing some concerns. Implementation should be peer-driven with healthcare provider oversight.

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          Most cited references26

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          HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

          Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.
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            A Global Review of HIV Self-testing: Themes and Implications.

            HIV self-test kits may have the potential to increase testing rates around the globe, and thereby lead to reductions in HIV-related incidence and mortality. However, the effectiveness of these self-test kits and the issues surrounding self-testing have been greatly debated in recent years. We conducted a literature review on the acceptability, feasibility, and effectiveness of HIV self-testing (HST) around the world. Of the 28 articles abstracted, several themes of HST were explored, including behavioral risk compensation, presence of counseling, uses of HST, ability to perform the self-test, sensitivity and specificity, concordance with confirmatory testing, perceptions surrounding HST, instruction and supervision, and cost. Overall, this literature review found that this diverse group of participants generally performed HST correctly with a few exceptions, were accepting of the test if available at a relatively low cost, and preferred the oral-based HST over the blood-based test.
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              Acceptability of HIV Self-Testing in Sub-Saharan Africa: Scoping Study.

              Several HIV testing models have been implemented in sub-Saharan Africa (SSA) to improve access to HIV testing, but uptake remains poor. HIV Self-Testing (HIVST) is now available, and may serve to overcome barriers of current testing models which include stigma, discrimination and non-confidential testing environments. A scoping study was conducted to provide an overview of the current literature in SSA, as well as identify future research needs to scale-up HIVST and increase HIV testing uptake. The outcome of the review indicated only 11 reported studies to date, showing variable acceptability (22.3-94%) of HIVST, with acceptability of HIVST higher among men than women in SSA. We conclude that research around HIVST in SSA is still in its infancy, and further implementation research and interventions are required to improve acceptability of HIVST among diverse study populations, failing which policy adoption and scale-up may be hindered.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: Formal analysis
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Conceptualization
                Role: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: MethodologyRole: Resources
                Role: ConceptualizationRole: Methodology
                Role: ConceptualizationRole: MethodologyRole: ResourcesRole: Supervision
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 July 2020
                2020
                : 15
                : 7
                : e0236052
                Affiliations
                [1 ] Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
                [2 ] Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
                [3 ] Nkaikela Youth Group, Gaborone, Botswana
                [4 ] Ministry of Health & Wellness, Gaborone, Botswana
                [5 ] University of Botswana, Gaborone, Botswana
                [6 ] University of Heidelberg, Heidelberg, Germany
                [7 ] Wellcome Trust Africa Centre for Health and Population Studies, Durban, South Africa
                [8 ] RAND Corporation, Santa Monica, CA, United States of America
                [9 ] Brigham and Women's Hospital, Boston, MA, United States of America
                University of Ghana College of Health Sciences, GHANA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-9288-7881
                Article
                PONE-D-20-07870
                10.1371/journal.pone.0236052
                7384658
                32716966
                56391c4f-382c-4355-ad24-00f3c578b96b
                © 2020 Shava et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 March 2020
                : 26 June 2020
                Page count
                Figures: 0, Tables: 2, Pages: 11
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100007301, Harvard University Center for AIDS Research;
                Award ID: HU CFAR NIH/NIAID fund 5P30AI060354-15
                Award Recipient :
                Funded by: NIH/Fogarty International Center
                Award ID: R21TW011069
                Award Recipient :
                Funded by: NIH/NIMH
                Award ID: P30MH058107
                Award Recipient :
                E.S was supported by Harvard University Center for AIDS Research (HU CFAR NIH/NIAID fund 5P30AI060354-15). L.M.B was supported by NIH/Fogarty International Center R21TW011069 and NIH/NIMH P30MH058107. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
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                Microbial Pathogens
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                Lentivirus
                HIV
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                Pathogens
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                Custom metadata
                The relevant supporting data have been shared in the paper and as supporting information files. We shared the data points used to calculate the means for age, as well as results in the form of qualitative codebooks with quotes. However, given the vulnerable population enrolled in this study, we did not obtain participant consent to share full interview transcripts. Data can be accessed by applying to the Botswana Ministry of Health and Wellness Human Research Development Committee (HRDC). IRB contact: Seeletso Mosweunyane (Head of Health Research Unit, Ministry of Health and Wellness, Botswana; phone: +2673914467; email: smosweunyane@ 123456gov.bw ). Data requests may be sent to the Botswana Harvard AIDS Institute Partnership (BHP) on the following emails: info@ 123456bhp.org.bw or tsekoto@ 123456bhp.org.bw Specifications: Ikitse Study, BHP Study 103.

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