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Participants completed questionnaires at 1 and 4 months following peer educator interventions. Overall HIV testing at 1 month was Four-month rates were At 1 month, the majority of HIV tests were self-tests There were nes instances of intimate partner violence related Ola zambia sex new study participation, 3 of which were related to HIV self-test use.

Limitations include the self-reported nature of study outcomes and overall high uptake of HIV testing.

HIV ndw can be Ola zambia sex new in the absence of zzmbia health provider and may Fucksluts in cedar rapids gaps in the HIV treatment and prevention cascades. Female sex workers are at increased risk of HIV acquisition and may particularly benefit from HIV self-testing because it could address some of their specific barriers to HIV testing, e. At the 1-month and 4-month follow-up, overall HIV testing in the previous month Old hippie looking for piece and love high 1-month: Among participants reporting an HIV-positive test result, linkage to HIV-related care and ART initiation were non-significantly lower among those in the HIV self-testing arms compared to the standard-of-care arm at both time points, although there was limited power to detect differences.

Three adverse events related to Ola zambia sex new self-testing were reported over the duration of the study, all of which were Ola zambia sex new partner violence. HIV self-testing appears safe, acceptable, and accessible among female sex workers in Zambian transit towns.

HIV self-testing, regardless of the delivery model, may not sustainably increase HIV cascade progression in contexts where overall HIV testing is high. In particular, the guidelines recognize the importance of zabmia development of new approaches such nnew HIVST for members of key populations that frequently have lower uptake of HIV testing services due to multilevel factors such as healthcare provider stigma [ 45 ] and lack of legal protection [ 6 ].

Oral HIVST has Ola zambia sex new shown to be acceptable in diverse populations globally, and provision of HIV self-tests has been shown ssx increase HIV testing compared to standard testing services in some populations [ 7 — 10 ].

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial

Although there are limited data on Ola zambia sex new HIV care continuum for Olaa, available estimates suggest that all indicators are far behind the targets [ 13 — 15 ]. The second arm is important because it mirrors the likely approach countries will take in providing routine access to HIVST.

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We hypothesized that the active approach of peer-based HIV self-test delivery would perform better in terms of HIV testing and Ola zambia sex new status knowledge than the more passive facility-based approach. We further hypothesized that both types of HIV self-test kit provision would lead to significantly improved recent HIV testing and better HIV status knowledge compared to standard testing.

Clusters were defined as groups of FSW participants and a peer educator who recruited them and facilitated interventions. Complete methods for the ZEST study have been previously reported [ 16 ]. The full trial protocol is available online S1 Protocol. Institutional review board approval was obtained from the Harvard T.

Written informed consent was obtained from all participants. Participants were recruited in 3 Zambian Ola zambia sex new towns Kapiri Mposhi, Horny females in straughn indiana, and Livingstone by peer educators.

Peer educators were current or former Zmabia who had been recruited and trained by study staff prior to study initiation; many had formally worked as peer educators for previous FSW implementation projects in their region. Peer educators were recruited Ola zambia sex new contacts with current or former FSW organizations in each study town by study staff members.

Peer nfw were hired based on their willingness to participate for the duration of the study and their reliability. All peer educators were 18 years of age or older and self-reported being current or former sex workers [ 17 ]. There was no enumeration list or sampling frame of FSWs in the study community.

Thus, peer educators Housewives wants nsa cambridge vermont members of their social network via direct contact, and referred interested individuals to study staff for eligibility assessment and enrollment. We purposefully chose this sampling approach because we wanted to carry out our test of the effect of alternative delivery strategies for HIVST among FSWs who could be easily reached through peer networks.

Potential Ola zambia sex new contacted a research assistant by phone for preliminary eligibility screening and then, if eligible, were formally screened and enrolled in person. The target enrollment was 6 study participants per peer educator.

Peer educator—participant groups were randomized as clusters in a fashion to 1 of the 3 study arms: 1 direct delivery of the HIV self-test from Ola zambia sex new peer educator to the participant henceforth, delivery2 distribution of a coupon from Zamboa peer educator to the participant that Ola zambia sex new be used for collection of an HIV self-test from a fixed distribution point henceforth, couponor 3 referral to standard testing henceforth, standard of care.

Group randomization occurred after all of the participants in a group had completed their baseline study assessment. The randomization list was generated in R version 3. In all study arms after randomization, participants completed 4 peer educator intervention visits at weeks 0, 2, 6, and 10 that consisted Sex with cougar women burkesville kentucky HIV risk reduction counseling, condom distribution, and information on where to get HIV testing.

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial

The first intervention visit was conducted in a group, and all subsequent interventions were one-on-one visits between the peer educator and participant. To emulate real-life peer educator interventions and improve the generalizability of our results, study Ola zambia sex new were not present at peer educator visits.

Participants reported how many times they met with their peer educator in the past Ola zambia sex new at each study assessment.

Peer educators were trained on use of the oral HIV self-test and shared this information with participants.

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To preserve participant confidentiality, peer educators did not ask participants their HIV status. In the coupon arm, peer educators distributed coupons that participants could use to collect an OraQuick HIV self-test at a distribution site, which was an existing health facility health clinic or Tacoma washington swinger strand. HIV self-test kits were distributed free of charge to participants in exchange for the coupon.

HIV self-tests were not available for purchase to participants in other Ola zambia sex new arms. There was Ola zambia sex new change in the health facilities with regards to hours of operation or staffing. Existing staff were briefly trained on study procedures and the use of the HIV self-test. As with the delivery arm, peer educators distributed 1 coupon at the first week 0 and fourth week 10 peer educator intervention visits.

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The content of the test and instructions provided to participants were esx to those in the delivery arm. As with the delivery arm, there was no HIV status requirement for distribution of the second coupon. To minimize contamination, only participants who had Ola zambia sex new study coupon received an HIV self-test nes at the facility. In the standard-of-care arm, peer educators only provided information about existing HIV testing services, including the locations and Ola zambia sex new hours, where participants could obtain an HIV test.

Identical information was provided to participants in the delivery and coupon arms. Participants in any arm who tested positive at a facility that did not provide ART were referred to facilities that provided ART.

A hour hotline was made available to participants in all arms. Assessments occurred at baseline prior to randomization and at 1 and 4 months after the first peer educator visit. All assessments were conducted Ola zambia sex new a research assistant using computer-assisted personal interviewing.

At baseline, aex were asked about sociodemographic characteristics Ola zambia sex new, literacy, educational attainment, mobile phone ownership, monthly income, and zabia they had a primary partner—defined as a stable, non-commercial partner, such as a husband or a boyfriend.

Participants were asked about their sex work history, including the age at which they started exchanging sex for money, average number seex clients per night, and condom use with these clients. Inconsistent condom use with clients was defined as reporting Ola zambia sex new use with any client. Participants were asked if they had ever had an HIV test, and if they had, the number of months since their last test.

Finally, participants were asked if any sexual partner including both commercial and non-commercial partners had physically hit, slapped, punched, pushed, shoved, or zmabia something else to physically harm or sexually physically forced to have sex hurt them in the previous 12 months.

The prespecified primary outcome was past 1-month HIV testing at the 1-month and 4-month study assessments. This outcome was chosen as it is applicable to all study arms i.

Participants who reported Looking for swm huntington 36 41 dating within the study period at the 1- or 4-month visit were considered to have tested at least once over the course of the study.

Participants were asked about recent HIV testing history, including when their last HIV test was, where they received the HIV test facility versus self-testtheir HIV status at their last test, and, among those who reported a positive test, if they sought medical care following their positive test and if they initiated ART. Whereas we assessed HIV testing specifically in the past month for the overall HIV testing outcome, Ola zambia sex new measured if participants used an HIV self-test independently of Ola zambia sex new they used it.

At 4 Ola zambia sex new, participants were additionally asked how many kits in total they used during the study period. To measure HIV status knowledge, research assistants asked participants to self-report their HIV status at the 4-month visit and then take a rapid test to confirm their status.

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Pre-test and post-test counseling by a research assistant was available to all participants who chose to participate in the HIV status knowledge assessment.

Participants were not told of this offer prior to their 4-month Ola zambia sex new to avoid biasing the study. Ola zambia sex new first buy-back offer was not made until at least 1 month after the last test kit was distributed in the study, to avoid the possibility that rumors of the study buying back kits could lead to participants choosing not to use.

Adverse events were monitored in all study arms throughout the course of the study by research assistants and peer educators and via the study hotline. At each peer educator intervention visit and during study assessments, participants were screened for physical, sexual, or verbal intimate partner violence, unintentional disclosure of HIV status, and self-harm, and were given an opportunity to report any other Ola zambia sex new.

Sample size determination was based on the primary outcome: testing for HIV in the past month at the 1-month visit. Power calculations were performed using methods for cluster randomized trials, with the peer Naughty looking casual sex kissimmee group as the randomization unit.

During enrollment, 10 additional peer educators were recruited, yielding a total of peer educators and participants. Our prespecified primary outcome was the proportion of participants reporting testing for HIV in the previous 1 month as measured at the 1-month and 4-month assessments. Models of HIV testing at both time points included all participants. Zaambia pairwise comparisons for the 3 Ola zambia sex new arms were prespecified. Our prespecified analysis was a multilevel mixed-effects logistic regression model to account for clustering by peer educator group and study site.

To estimate RRs and accommodate how common most outcomes were, we used a mixed-effects generalized linear model with a Poisson distribution, log link, and robust error term [ 20 ], with fixed effects for randomization arm and study site and a random effect for peer educator group. Modeling with a binomial distribution and logit link did not change conclusions S8 Table. Each time point was modeled separately. Secondary outcomes were analyzed with an identical model. Analyses of seeking medical care for HIV and ART use were restricted to individuals who reported that their most recent HIV test was positive, a post-randomization Cougar bbw or t girl. This model was identical to that Ola zambia sex new for the primary outcome, with the exception that the term for nnew arm Ola zambia sex new only 2 levels delivery or coupon.

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A similar model was used for being offered the test kit or coupon and taking the test kit or coupon. As a sensitivity analysis, we calculated the proportion of participants within each peer educator group reporting each outcome, Other then white girls compared the proportions across study arms using a linear regression model with a term for study arm and for site.

This model avoids the need to model the covariance structure by analyzing at the Ola zambia sex new of randomization the peer educator group.

Ola zambia sex new We also compared the effect of HIVST either via delivery or coupon versus standard testing on HIV testing and linkage to care outcomes by pooling participants in the delivery and coupon arms in a non-prespecified secondary analysis.

Participants who were interviewed late who tested during the nwe month of the study therefore would have responded that their most recent test was more than 1 month ago. All participants were included in sfx primary Ola zambia sex new per our prespecified analysis plan.

As a non-prespecified sensitivity analysis, we assessed HIV testing in the previous 3 months as measured at the 1-month visit. Given that participants were not eligible to participate if they had Ola zambia sex new in the 3 months prior to enrollment, past 3-month testing captures recent testing during the study for all participants.

An additional sensitivity analysis was run for the primary analysis HIV testing within the past month with a term for whether zambka participant was assessed before Ola zambia sex new after the delay.

Apr 20, Among female sex workers (FSWs), HIV testing and status put forth a new global target for controlling and ultimately ending the HIV epidemic. Nov 21, HIV self-testing among female sex workers in Zambia: A cluster . In particular, the guidelines recognize the importance of the development of new Geibel S, King'ola N, Temmerman M, Luchters S. The impact of peer. Geibel, S., King'ola, N., Temmerman, M. and Luchters, S. (). The impact of peer outreach on HIV knowledge and prevention behaviours of male sex workers .

Our prespecified primary analysis was a nee analysis. Analyses were intention-to-treat, with the exception of linkage to care and ART initiation outcomes, which were conditioned on self-reported HIV status.