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HIV InfectionZESTNCT02827240

Zambian Peer-Educators for HIV Self-Testing Study

A study testing Oral HIV Self-Testing in people with HIV Infection, run by Harvard School of Public Health (HSPH) at 3 sites in Zambia.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

ZEST is a cluster-randomized trial designed to determine whether HIV self-tests are acceptable and improve HIV testing rates and HIV status knowledge among female sex workers in Zambian transit towns. Read more about this study

Who is it for?
Ages 18 years and older, women onlyHealthy volunteers can take part
Conditions the study is for
HIV Infection
What is being tested?
Oral HIV Self-Testing
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
965 participants
Where
3 sitesZambia
Study dates
Aug 2016to Jun 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • 18 years of age or older
  • Female sex
  • Reports exchanging sex (including vaginal, anal, and/or oral) for money or goods at least once in the past month
  • Self-reported HIV negative with last HIV test at least 3 months OR HIV status unknown
  • Permanent residence in the study town of enrollment (Kapiri, Livingstone, or Chirundu)
  • Willing to be visited by and meet with assigned peer educator on a monthly basis over the 4-month study period

Who cannot join

  • Less than 18 years of age on the enrollment date
  • Has not exchanged any form of sex in the past one month
  • Self-reported to be living with HIV
  • Self-reported HIV negative status and tested within the past 3 months
  • Living in PopART catchment area (Livingstone only)
  • Concurrently participating in another HIV prevention study
  • Meets criteria but does not wish to participate
  • Other

Trial locations and contacts

3 sites in 1 country.

Zambia3 sites
  • John Snow, Inc

    Chirundu

  • John Snow, Inc

    Kapiri

  • John Snow, Inc

    Lusaka, Livingstone

Other trials in Zambia

About this study

Official title: A Peer Educator-delivered HIV Self-testing Intervention for Female Sex Workers in Zambian Border Towns

ZEST is a cluster-randomized trial designed to determine whether HIV self-tests are acceptable and improve HIV testing rates and HIV status knowledge among female sex workers in Zambian transit towns. This study will determine whether directly giving participants an HIV self-test or giving them a coupon to collect a test at a drug store or clinic improves outcomes compared to standard of care.

Read the detailed description

Although Zambia has a generalized HIV epidemic, with approximately 13.3% of adults aged 15 to 49 living with HIV, the epidemic remains even more highly concentrated in key populations, including female sex workers (FSW). A particular concern for FSW is access to healthcare services, including HIV testing services. FSW face significant barriers to accessing healthcare. In other settings, evidence has suggested that stigma is a significant barrier to FSW seeking HIV testing. It is likely that similar mechanisms exist in Zambia. Evidence from Zambia has indicated that complex multilevel factors, such as stigmatization and harassment, contribute to vulnerability among FSW. User-controlled HIV prevention interventions that lead to empowerment of FSW may therefore be a powerful way to address the HIV epidemic in this key population.

Oral HIV self-testing consists of an oral swab kit that allows individuals to test for HIV in the privacy of their own homes whenever they want. The ease of use of HIV self-testing, that it can be done at any time, and that is completely private may make it an attractive alternative to currently-available HIV testing mechanisms for FSW in Zambia. HIV self-testing has generally been shown to be acceptable in a variety of populations, however evidence related to its uptake and acceptability remain sparse, especially among key populations and in Sub-Saharan Africa. This research will provide rigorous evidence of the uptake and efficacy of HIV self-testing for this population.

ZEST was designed to determine whether either direct distribution of HIV self-test kits via peer educators or distribution of HIV self-tests via coupons that participants can use to collect kits at collection points such as drug stores or health posts leads to better coverage of HIV testing and better awareness of HIV status. ZEST is a cluster-randomized trial in which peer educators recruit a small group of FSW participants, and the peer educator group is randomized to one of three study arms: 1) direct distribution of test kits, 2) fixed distribution of test kits, or 3) referral to standard of care HIV testing. The primary outcome is HIV testing in the past month measured at one and four months after the first peer educator visit (when the test kits or coupons are distributed in the intervention arms).

Conditions
HIV Infection
Being tested
Oral HIV Self-Testing
Keywords
Female sex workers, HIV testing, HIV self-test
Medical subject headings
HIV Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Oral HIV Self-TestingOther

    Also called OraQuick HIV Self-Test

    The Oral HIV Self-Test is an in-home test that uses an oral swab to collect samples of oral mucosa that is used to detect the presence of HIV antibodies. The test is read after 20 minutes by the user. The test can be done by an individual at any time and place of the user's choosing. The test is read visually.

Study groups in NCT02827240
Study groupRoleWhat they receive
Direct DistributionExperimentalThe direct distribution arm consists of peer educators directly distributing HIV self-test kits to participants. Peer educators will briefly describe HIV self-testing to participants but will not provide extensive training on the use of the test kit. Peer educators also provide referral to existing services for HIV testing.
Receives: Other: Oral HIV Self-Testing
Fixed DistributionExperimentalThe fixed distribution arm consists of peer educators distributing coupons to participants. The participants can then use the coupon to collect an HIV self-test kit at a participating distribution point, including drug stores, pharmacies, and health posts. Peer educators will briefly describe HIV self-testing to participants but will not provide extensive training on the use of the test kit. Peer educators also provide referral to existing services for HIV testing.
Receives: Other: Oral HIV Self-Testing
Referral to Existing ServicesNo interventionPeer educators will not provide HIV self-tests to participants. Peer educators will only provide referral to existing services for HIV testing.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. HIV testing in the previous month

    Measured: One month from first intervention visit

  2. HIV testing in the previous month

    Measured: Four months from first intervention visit

Secondary outcomes (26)
  1. Correct knowledge of HIV status

    Measured: Four months from first intervention visit

  2. HIV self-test kit use in the two intervention arms

    Measured: One month from first intervention visit

  3. HIV self-test kit use in the two intervention arms

    In the intervention arms

    Measured: Four months from first intervention visit

  4. Linkage to HIV care and confirmatory testing

    Measured: One month from first intervention visit

  5. Linkage to HIV care and confirmatory testing

    Measured: Four months from first intervention visit

  6. HIV risk perception and beliefs about acquiring HIV

    Measured: One month from first intervention visit

  7. HIV risk perception and beliefs about acquiring HIV

    Measured: Four months from first intervention visit

  8. HIV disclosure with sexual partners

    Measured: One month from first intervention visit

  9. HIV disclosure with sexual partners

    Measured: Four months from first intervention visit

  10. Condom use with commercial sexual partners since last visit

    Measured: One month from first intervention visit

  11. Condom use with commercial sexual partners since last visit

    Measured: Four months from first intervention visit

  12. Condom use with non-commercial sexual partners since last visit

    Measured: One month from first intervention visit

  13. Condom use with non-commercial sexual partners since last visit

    Measured: Four months from first intervention visit

  14. Average number of commercial sexual partners

    Measured: One month from first intervention visit

  15. Average number of commercial sexual partners

    Measured: Four months from first intervention visit

  16. Average number of non-commercial sexual partners

    Measured: One month from first intervention visit

  17. Average number of non-commercial sexual partners

    Measured: Four months from first intervention visit

  18. Intimate partner violence, including sexual, physical, or verbal

    Measured: One month from first intervention visit

  19. Intimate partner violence, including sexual, physical, or verbal

    Measured: Four months from first intervention visit

  20. HIV fatalism

    Measured: One month from first intervention visit

  21. HIV fatalism

    Measured: Four months from first intervention visit

  22. Self-reported self-efficacy as measured by the General Self Efficacy Scale

    Measured: One month from first intervention visit

  23. Self-reported self-efficacy as measured by the General Self Efficacy Scale

    Measured: Four months from first intervention visit

  24. Female sex worker empowerment as measured by Beattie et al 2014

    Measured: One month from first intervention visit

  25. Female sex worker empowerment as measured by Beattie et al 2014

    Measured: Four months from first intervention visit

  26. Pre-exposure prophylaxis preferences

    Measured: One month from first intervention visit

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Jul 2016 (estimated)
  2. Study startAug 2016
  3. Primary completionMar 2017
  4. Study completionJun 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
965 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02827240
Sponsor's protocol ID
7041968-01
Acronym
ZEST
Status last verified
May 2018
First submitted
30 Jun 2016
Last updated
7 May 2018
Results posted
No
Data monitoring committee
No
Individual data sharing
Yes: De-identified data will be made available via International Initiative for Impact Evaluation's public access data repository.

Publications

  • Harling G, Chanda MM, Ortblad KF, Mwale M, Chongo S, Kanchele C, Kamungoma N, Barresi LG, Barnighausen T, Oldenburg CE. The influence of interviewers on survey responses among female sex workers in Zambia. BMC Med Res Methodol. 2019 Mar 15;19(1):60. doi: 10.1186/s12874-019-0703-2.

    PubMed 30876402
  • Ortblad KF, Chanda MM, Musoke DK, Ngabirano T, Mwale M, Nakitende A, Chongo S, Kamungoma N, Kanchele C, Barnighausen T, Oldenburg CE. Acceptability of HIV self-testing to support pre-exposure prophylaxis among female sex workers in Uganda and Zambia: results from two randomized controlled trials. BMC Infect Dis. 2018 Oct 4;18(1):503. doi: 10.1186/s12879-018-3415-z.

    PubMed 30286737
  • Oldenburg CE, Chanda MM, Ortblad KF, Mwale M, Chongo S, Kamungoma N, Kanchele C, Fullem A, Moe C, Barresi LG, Harling GD, Barnighausen T. Effect of HIV self-testing on the number of sexual partners among female sex workers in Zambia. AIDS. 2018 Mar 13;32(5):645-652. doi: 10.1097/QAD.0000000000001740.

    PubMed 29494424
  • Chanda MM, Ortblad KF, Mwale M, Chongo S, Kanchele C, Kamungoma N, Fullem A, Dunn C, Barresi LG, Harling G, Barnighausen T, Oldenburg CE. HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial. PLoS Med. 2017 Nov 21;14(11):e1002442. doi: 10.1371/journal.pmed.1002442. eCollection 2017 Nov.

    PubMed 29161260
  • Oldenburg CE, Ortblad KF, Chanda MM, Mwanda K, Nicodemus W, Sikaundi R, Fullem A, Barresi LG, Harling G, Barnighausen T. 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. BMJ Open. 2017 Apr 20;7(4):e014780. doi: 10.1136/bmjopen-2016-014780.

    PubMed 28428187

Questions about this trial

What is this clinical trial studying?

A study testing Oral HIV Self-Testing in people with HIV Infection, run by Harvard School of Public Health (HSPH) at 3 sites in Zambia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 May 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Zambia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

HIV testing in the previous month (time frame: One month from first intervention visit). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02827240, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 May 2018.

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Zambian Peer-Educators for HIV Self-Testing Study | AzTrials