Programme of Research on the Integration of HIV and Sexual Reproductive Health
Together with Zimbabwe Ministry of Health & Child Care (MoHCC), PSI Zimbabwe is implementing an integrated program for sexual and reproductive health services under the Integrated Support Programme (ISP). This includes integration of HIV services (HIV counselling and testing, treatment and prevention) and sexual & reproductive health (SRH) services including family planning and cervical cancer screening. CeSHHAR Zimbabwe is PSI’s operations research partner under this programme and will undertake a series of operational research to improve effectiveness and efficiency in service delivery in the ISP.
Funding Source: National Institutes of Health And Integrated Support Programme.
Funding Period: March 2013 to November 2016
HIV self-testing, where an individual collects their own sample and conducts the HIV test privately without a provider, has the potential to substantially scale up acceptability and access to testing both in the general population as well as in hard-to-reach populations, such as sex workers, in a manner that is low-cost, confidential, and empowering for users.
This research aims to:
Develop a culturally relevant set of materials for the promotion and support of HIV self-testing;
Determine acceptability and accuracy of self-testing; conduct a study in Shamva District to determine the preferred method of testing and where and why people chose to self-test;
Determine the accuracy of self-testing among sex workers and
Among sex workers, compare uptake of testing using self-testing with standard testing;
Pilot community-based distribution of HIV self-test kits in Mazowe District.
There are high rates of new HIV infections among young people, particularly young women. Despite this there is suboptimal knowledge of HIV status in this group
Through this UKRI MRC/DFID funded research (African Research Leader Scheme) we are evaluating HIV self-test distribution models that have potential to improve uptake of HIV testing among tertiary education students
Through the research will also determine how models that have been developed for HIV self-testing can be adapted for other conditions of public health importance
Community-led HIV self-testing (conducted through STAR initiative)
Funding Source: UNITAID through PSI
Funding Period: September 2015 to September 2020
Community-led distribution of test kits
Given the bene?ts of community-based self testing, we evaluated community-led distribution of HIV self-tests where rural communities took a lead in designing and implementing their own self-testing models
In a cluster randomised trial that was conducted among 40 village groups (headman units), we found that community-led distribution of self-tests can perform as well as community-based distribution by paid distributors, with lower costs in the first year of distribution. Specifically new HIV diagnosis was similar between the community-led distribution arm where distribution was done by paid distributors, 3.7% versus 3.6%, respectively, adjusted OR (aOR) 1.1 (95% CI 0.72 to 1.56); 318 (25.9%).
Linkage to post-test services was also similar, aOR 1.1 (95% CI 0.75 to 1.49). The cost per HIV self-test kit distributed was US$6.29 and US$10.25 for paid distribution and community-led self-testing, both lower than the 2016/2017 costs for newly implemented paid distribution model (US$14.52), see BMJ global health 2021; 6(Suppl 4).
We conducted a community learning event where communities described their enthusiasm about the community led model, what worked well, what worked less well and how it can be scaled up.
Funding Source: UNITAID through PSI
Funding Period: September 2015 to September 2020
Our largest body of work on HIV self-testing was through the STAR Initiative, a game changing project led by Population Services International (PSI) working in collaboration with World Health Organisation (WHO), London School of Hygiene & Tropical Medicine (LSHTM), Liverpool School of Tropical Medicine (LSTM), University College London (UCL), with local research partners in Zimbabwe, Malawi, Zambia, South Africa, Lesotho and the Kingdom of eSwatini, see link http://hivstar.lshtm.ac.uk/
Through the STAR Initiative we evaluated di?erent models of distributing HIV self-test kits. The largest evaluation is of the community-based distribution model, where we found that door-to-door distribution of self-tests kits in rural communities resulted in 89% of people reporting that they had ever tested for HIV, compared to an expected 75%. Initiation of antiretroviral therapy (ART), increased by 27% in health facilities whose catchment areas were self-testing communities, compared to those which were not, Figure, BMJ global health 2021; 6(Suppl 4).
Funding Source: UNITAID
Funding Period: September 2015 to August 2017
There is suboptimal uptake of HIV testing. Innovative methods are needed to increase the number of people who test for HIV and know their status. HIV self-testing is one such intervention that has potential to scale-up acceptability and uptake of testing; WHO recommends that countries conduct demonstration projects on HIVST.
Together with Ministry of Health and Child Care and the STAR Project, we are conducting this research in Zimbabwe. STAR is a three-country project (http://hivstar.lshtm.ac.uk/lshtm/) that is aimed at testing various models of providing HIV self-testing services and ensuring linkage of testers to appropriate HIV prevention and treatment services.
In Zimbabwe, we are evaluating uptake of self-testing and linkage to services after self-test kits are offered through the following models:
Community-based distribution by trained lay distributors in selected rural areas in Mberengwa, Buhera, Chivi, Gweru, Masvingo, Gutu, Mazowe and Bulilima.
Distribution at New Start Centres in Harare, Bulawayo, Gweru, Masvingo, Chitungwiza and Mutare
Distribution through the Voluntary Medical Male Circumcision Program that is run by PSI Zimbabwe
Distribution through the Sisters Clinics of the Zimbabwe National Sex Workers Program
WHO is launching new HIV self-testing and partner notification guidelines for World AIDS Day 2016. In preparation for the launch they have produced a short video, WHO: HIV self-testing – Questions and Answers that explains HIV self-testing. Below is the video
Funding Source: Integrated Support Programme through PSI Zimbabwe
Funding Period: February 2013 to November 2016
As part of the Integrated Support Programme, PSI Zimbabwe has integrated sexual and reproductive health services with HIV testing and care services. CeSHHAR is PSI’s operations research partner; and the following studies are being conducted as part of the program:
Investigating barriers and facilitators to provision and uptake of long acting reversible contraception at PSI sites providing integrated services. In this study we will also determine the cost of integrated FP/HIV services in different service delivery settings from the perspectives of both the provider and clients.
Investigating barriers and facilitators to provision and uptake of cervical cancer screening at PSI sites providing integrated services. In this study we will also determine the cost of integrated services from the perspectives of both the provider and clients.
Non-monetary incentives to increase uptake of Couples HIV testing (CHTS).
CHTS, where couples test together with a counsellor and then develop a prevention and/or treatment strategy based on their joint status, is associated with a number of positive HIV prevention outcomes including increased condom use, reduction in sexual partners and increased use of antiretroviral therapy (ART) to prevent transmission of HIV to the uninfected partner.
Despite the clear recognition of the benefits of CHTS, its demand in Zimbabwe is low, especially in rural settings. CeSHHAR Zimbabwe in collaboration with PSI Zimbabwe and Ministry of Health and Child Care conducted a study to test the effectiveness of small, non-monetary incentives in increasing CHTC uptake in Chegutu, Goromonzi, Murewa and Uzumba Maramba Pfungwe (UMP) districts. We found that the offer of small non-monetary incentives was associated with a 13-fold increase in uptake of couples testing (https://youtu.be/NQhRW4mj26E).
Funding Source: Behavioural Economics in Reproductive Health Initiative (BERHI)
Funding Period: March 2014 to Nov 2016
Unmet need for family planning (FP) is unacceptably high in developing countries. Despite effectiveness and reliability of long acting reversible contraceptives (LARC) their uptake is low; most Zimbabwean women use short-acting, user dependent FP methods. CeSHHAR Zimbabwe and UC Berkeley are conducting research on how to best promote uptake of LARC.
The study aims to understand whether women accept receiving LARC information and other reproductive health topics from their hairdressers, and whether discussing these topics with hairdressers results in increased LARC uptake.
Through a cluster-randomised trial, the study also seeks to determine whether incentivising hairdressers who have been trained to talk about LARC according to successful referrals (for any service) to Chitungwiza New Start Centre will result in higher LARC uptake. Data collection is complete and analysis is ongoing.