2020 - 2024
Principal Investigator(s):
Nabila El-Bassel, PhD
Victoria Frye (contact), DrPH
Co-Investigator:
Brooke West, PhD
Laura Starbird, PhD
Project Director:
Meruyert Darisheva
Summary
The primary goal of this study is to assess acceptability, feasibility, preliminary efficacy and cost of a peer-based HIV self-testing intervention to increase consistent HIV testing among women who exchange sex and inject drugs in Kazakhstan.
Abstract
Central Asia (CA) has one of the world’s fastest growing HIV epidemics, increasing 30% since 2010. By 2017, key populations and their sex partners made up 95% of new HIV infections, including 9% among female sex workers (FSW), 39% among people who inject drugs (PWID), and 28% among clients/sex partners of sex workers/other key populations. In Kazakhstan, a major CA regional economy, there was a 106% increase in new HIV infections from 2010 to 2017. FSW who also inject drugs (FSWID) are at significantly increased risk of HIV infection, but are less likely to engage in HIV testing and receive care. HIV testing is the key point of entry to HIV care and ART, and, for HIV-negative individuals, to PrEP/PEP. In Kazakhstan, barriers to HIV testing for FSWID, include stigma, inconvenience, and negative staff attitudes related to women’s status as FSW and/or drug users. Although HST is recommended by the WHO, very limited research on FSW and PWID exists. A recent review described just two qualitative studies of HST among FSW; another review of HST interventions reported no completed studies among FSW. Evaluations of HST programs for FSW in sub-Saharan Africa are underway, but are unpublished. Importantly, no HST studies have been conducted in CA or, to our knowledge, among FSWID, a vital population to target given their elevated risk for HIV, low uptake of HIV testing, and experiences of dual stigma.
Phases of the Study
- In Phase 1, we will conduct formative research (20 in-depth interviews) to identify responses to existing test option characteristics and key elements of an HST intervention.
- In Phase 2, we will engage systematic intervention adaptation to optimize fidelity and fit related to social and cultural context, content, delivery personnel and HIV test method preferences.
- In Phase 3, we will randomize 90 HIV-uninfected FSWID and one peer support provider to either the adapted experimental condition (2 baseline/2 reminders) or a time- and attention-controlled standard HIV test-counseling condition and follow for 12 months for impacts on consistent HIV testing and linkage to care if positive.
Results will fill key gaps in the knowledge base around optimal HST implementation among FSWID and 90-90-90 goals, through analysis of an innovative peer-support intervention with an explicit focus on substance using populations. Results will have relevance for HST in other CA countries, as well as the 120 countries that have HIV epidemics where FSW and PWID play important roles.
Co-PI Dr. Frye on the importance of this research
The research in Kazakhstan is important for several reasons. First, injection drug use is central to the HIV epidemic in Central Asia, as is the vulnerability to HIV that sex work confers at times and depending upon the context of the sex work. Second, PrEP is just being implemented in these areas and there is a need to connect women to PrEP using methods and approaches under their own control and enhancing their network’s knowledge, such as self-screening for HIV, and addressing the role that HIV and related stigma plays.
Further, COVID-19 has changed the context for HIV prevention in Central Asia and for drug-involved and sex work/exchange communities. The role of self-screening, stigma, peer support and telehealth may be increasingly important in this new context, both in Central Asia and other middle-income areas of the world, just as it is in the US.
Publications:
