Encouraging female sex workers to self-test for HIV in Uganda
Context
HIV testing is considered the important first stage of HIV treatment, care and prevention. In Sub-Saharan Africa, female sex workers (FSWs) are at particular risk of HIV and have the highest prevalence. However, they face numerous barriers to HIV testing, including stigma, discrimination, transport costs and other logistical hurdles.
HIV self-testing (HIVST) has been identified as a solution to these barriers. Many studies have demonstrated acceptability and accuracy of HIVST among the general population, but very few have considered how they could be delivered to and taken up by FSWs. Not enough evidence was available to determine whether HIVST increased the number of FSWs who knew their HIV status.
Given this knowledge gap, in 2016, 3ie supported researchers from Harvard University; the University of California, San Francisco; the University of Heidelberg; and multilateral organisations explored the effects of HIVST delivery models amongst FSWs in Kampala, Uganda.
In cluster randomised controlled trials, participating FSWs received one of three types of services: direct peer provision of an oral HIVST kit; peer provision of a coupon exchangeable for oral HIVST kits in 10 designated healthcare facilities; or standard care.
Evidence
The findings demonstrated that providing oral self-test kits was effective in increasing HIV testing amongst FSWs and that it was a more effective approach than either of the other delivery models. The study also showed that HIVST could be a viable approach in leading FSW to take pre-exposure prophylaxis (medicine to prevent HIV) regularly.
Evidence impacts
Type of impact: Change policies or programmes
Decision makers use findings from an evaluation or systematic review to adjust their programming to fix targeting, cash transfer amounts, training modules or other factors that inhibit the policy or programme’s ability to achieve its intended impacts.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowIn 2018, Uganda’s Ministry of Health released an addendum to its national HIV Testing Services Policy, which recommended the direct provision of HIVSTs to FSWs. This decision was based on the compelling evidence from this 3ie evaluation, early engagement by the researchers with decision makers, and promising evidence from 3ie studies conducted elsewhere as part of the same evidence programme.
‘[Ministry of Health] officials were involved in the project throughout. The dissemination plan was effective. The final workshop was covered in media the next day. Uganda was ready to adapt HIVST before these trials and that motivated them to use it. And as the study came out, [the direct provision approach] has been used because of the positive results.’
Type of impact: Inform global guidelines and policy discussions
When findings from an evaluation or review can be traced to discussions or actions. Examples include governments or multilateral or bilateral donors’ mentioning the findings to inform policy or programming. To date, we have only one case of an individual impact evaluation informing global health guidelines. WHO guidelines require that the guidance is based on randomised evaluation evidence.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowThe World Health Organization (WHO) guidelines on HIV testing strongly recommend offering HIVST as an approach to HIV testing services, citing evidence from various sources, including the research conducted by 3ie. The recommendation appears in the organisation's Consolidated guidelines on HIV testing services released in December 2019. These update the previous guidelines on HIV Self-testing and Partner Notification released in 2016, and the numerous annexures to the 2016 guidelines. The updated guidelines note that HIVST has emerged as an effective tool to expand testing among people at risk of HIV who may not otherwise test and those at ongoing risk who need to test frequently.
Suggested citation
International Initiative for Impact Evaluation (3ie), 2020. Encouraging female sex workers to self-test for HIV in Uganda [online summary], Evidence Impact Summaries. New Delhi: 3ie.
Related
Preparation meets opportunity: how 3ie’s stakeholder engagement paid off on HIV self-testing
This blog highlights how Uganda’s government engaged with the evidence from 3ie’s HIV self-testing evidence programme.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to influence@3ieimpact.org
Last updated on 13th November 2020