STAR II

What is the STAR Study?

The acronym STAR is for Self-testing AfRica.

HIV Self Testing (HIVST) is a new phenomenon in Africa and has the potential to reach the unreached population who are not aware of their status. Despite this potential, there is little evidence on acceptability, feasibility, user accuracy and effectiveness of different HIVST delivery models for Zambia.

History of STAR

STAR Phase 1 started in 2016 and was aimed to look at increasing the UPTAKE of quality-assured HIV-ST among the general urban and rural population in the countries of implementation- Malawi, Zambia & Zimbabwe. In Zambia, the project partners were Society for Family Health (SFH), Population Services International (PSI), Zambart, London School of Hygiene and Tropical Medicine (LSHTM) and Liverpool School of Tropical Medicine (LSTM).

STAR Phase II recently commenced in Zambia with the same partners as in phase 1. Zambart will conduct case studies in five models of the HIVST distribution to understand the acceptance and use of HIVST distributed using primary and secondary distribution models. The case studies will also generate approaches for anticipating and reporting HIVST related social harms, and in the two secondary distribution models we will recruit a qualitative and quantitative cohort to better understand uptake of secondary testing and linkage to care.

The study will be conducted in 5 peri-urban communities in Zambia with facility-led models to be implemented in the public health facilities and the community-led model to be implemented in all facility catchment areas. We will also purposively sample 2 workplaces where SFH will distribute HIVST.

Distributing the HIVST in the STAR II is being done by SFH and Ministry of Health (MOH) staff. The different distribution models that SFH and MoH are using include VMMC, Facility-led, Community-led, secondary distribution through ANC, secondary distribution through ART and Work place

The role of Zambart will be to evaluate the HIVST distribution models.

Five models of interest

Five primary and secondary distribution models (header/ title for the diagram below)

Case Study Outcomes and expected use

Outcomes from this study will:

• Inform early scale-up and guideline development for approaches to distributing HIVST in Zambia
• Provide in-depth understanding of five promising distribution models
• Describe from user and provider perspectives, experiences and the contextual factors that affect the acceptability of HIVST
• Provide policy makers with relevant cost data to allow informed decisions about which models provide best value for money