Pilot implementation of HIV self-testing delivery in private pharmacies combined to a Respondent Driven Sampling method to improve HIV testing for MSM and TGW in Phnom Penh

Abstract

Primary objective

Evaluate the feasibility of HIV self-testing (HIVST) delivery by a private pharmacy network among men who have sex with men (MSM) and transgender women (TGW) recruited through a classic and digital Respondent Driven Sampling method to improve HIV testing in Phnom Penh, Cambodia

Secondary objectives

• Evaluate the acceptability and appropriateness of the strategy
• Identify barriers and facilitators
• Estimate the linkage to confirmatory testing for those with a reactive test and linkage to HIV care and ART for those with a positive confirmatory HIV test
• Estimate linkage to pre-exposure prophylaxis (PrEP) services for negative participants
• Estimate the characteristics of participants and compare to those reported in Integrated Biological and Behavioral Survey (IBBS 2019) for MSM and TGW in Cambodia
• Evaluate the adherence of participants to a 6-monthly repeated HIV testing

Methodology

An interventional pilot study using a mixed qualitative and quantitative approach will be carried out in order to evaluate the feasibility, acceptability and appropriateness of the strategy and to identify barriers and facilitators.

The participant recruitment method will be designed as a Respondent Driven Sampling (RDS) by recruiting initial seeds both at hotspots and on social networks. Prior to seed recruitment, a consultative meeting will be conducted in order to optimise the selection criteria of the seeds. The seeds will then distribute electronic and paper coupons to their networks physically and via social media, messaging and calling applications such as Twitter, Whatapp and Telegram (e-coupons). Each recruited participant will bring the coupon to be scanned at partner pharmacies to receive direct and free access to one HIVST kit. Partner pharmacies with a proper dedicated room/space securing privacy and secrecy in Phnom Penh are the study sites. There, trained community workers who get notified by partner at each visit of participant will do the study visit including information/consent, e-CRF filling and give a link of an external website to send the HIV test results and receive information or advices. These recruited individuals will be considered as wave 1 of recruitment and will each receive 10 additional coupons to recruit the members of their networks. The next round of individuals recruited and enrolled will be considered as wave 2, and so on.

After 6 months, a qualitative assessment via focus groups will be conducted among MSM, TGW and pharmacists to evaluate feasibility, acceptability and appropriateness of the intervention and to identify barriers and facilitators.

Several ART sites/HIV clinics particularly in charge of key populations will be specifically selected as participating centers in order to collect information on linkage to care or prevention services for positive and negative participants, respectively.

Each participant will be followed during 18 months and encouraged to perform a 6-monthly HIV testing during this period.

Expected enrolment

A pragmatic approach is carried out in which the enrolment will be stopped at the end of the inclusion period or if the number of participants reaches a maximum of 1500.