The Zambia Peer Educators for HIV Self-Testing (ZEST) study

Building on a strong history of innovative HIV treatment in Zambia, JSI implemented a pilot study in collaboration with Harvard University, T.J Chan School of Public Health which was designed to inform introduction and scale up of HIV self-testing targeting for female sex workers. The Zambia Peer Educators for HIV Self-Testing (ZEST) study took place during 2016 in three of Zambia’s major transportation hubs: Livingstone, Kapiri, and Chirundu.

Funded by the International Initiative for Impact Evaluation (3ie) and implemented in collaboration with the Ministry of Community Development Mother and Child Health (MCDMCH), the study was designed to help the Government of Zambia fulfill its obligation to UNAIDS’ 90-90-90 strategy by ensuring 90% of those living with HIV know their status by 2020.

Research from 2013 estimates that nearly 18% of infections in women in Sub-Saharan Africa were among FSWs. In order to reduce the number of FSW HIV infections, it is critical to have acceptable and accessible HIV testing which limits barriers to the test and subsequent referral to and use of services. To meet this need, the study evaluated ways to increase FSW testing coverage and status knowledge by establishing a preferred distribution mechanism of HIV self-testing kits.

In order to increase FSW participation, the intervention was led by peer educators who were organized into three randomized groups. The results from the trial helped evaluate the efficacy of oral HIV self-testing and linkage to care for FSW with the intent to inform government policy for self-testing in the general population.

Results from the study have been published by BMJ Open: Zambian Peer Educators for HIV Self-Testing (ZEST) study rationale and design of a cluster randomised trial of HIV self-testing among female sex workers in Zambia