Formative assessment to identify perceived benefits and barriers of HIV oral self-testing among female sex workers, service providers, outreach workers, and peer educators to inform scale-up in Kenya

ABSTRACT

In Kenya, HIV prevalence estimates among female sex workers (FSWs) are almost five times higher than among women in the general population. However, only 68% of infected FSWs are aware of their HIV-positive status. We aimed to identify perceived benefits, opportunities, and barriers of HIV self-testing (HIVST) in improving testing coverage among FSWs. Twenty focus group discussions were conducted with 77 service providers, 42 peer educators (PEs) and outreach workers, and 37 FSWs attending drop-in centers (DiCEs) in four regions of Kenya. An additional 8 FSWs with HIV-negative or unknown status-completed in-depth interviews. Data were analyzed thematically. Acceptability of HIVST was high, with cited benefits including confidentiality, convenience, and ease of use. Barriers included absence of counseling, potential for inaccurate results, fear of partner reaction, possible misuse, and fear that HIVST could lead to further stigmatization. PEs and DiCEs were the preferred models for distributing HIVST kits. FSWs wanted kits made available free or at a nominal cost (100 Kenya Shillings or ∼USD 1). Linkage to confirmatory testing, the efficiency of distributing HIVST kits using peers and DiCEs, and the types and content of effective HIVST messaging require further research.

KEYWORDS:

• HIV/AIDS
• female sex workers
• HIV self-testing
• Kenya
• implementation science

Acknowledgments

The authors would like to thank the service providers, outreach workers, peer educators, and female sex workers who so generously shared their thoughts with us. The authors gratefully acknowledge the support from our research assistants in collecting the data presented in this report. The authors also acknowledge the invaluable contribution made by the four major KP programs in Kenya at the time, Impact Research and Development Organization, University of Nairobi/University of Manitoba, International Center for Research and Health Kenya (ICRHK), and International Medical Corps.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funding agencies.

Additional information

Funding

This project report has been supported [in part] by the U.S. President Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms as part of Cooperative Agreement number (5U2GPS002052).