Feasibility and acceptability of peer-led assessment of HIV risk among female sex workers in Zimbabwe

Introduction Female sex workers (FSWs) in sub-Saharan Africa are at higher risk of HIV acquisition and transmission. However, FSWs’ life experiences are heterogeneous and are important to characterise in order to tailor responses to individual needs. Peer microplanners are FSWs trained to engage other FSWs and offer each individual a tailored package of support. We sought to assess the feasibility, acceptability and fidelity of implementing peer-led assessments of risk. 

Methods: Between December 2020 and August 2021, we conducted a qualitative process evaluation study of the Adapted Microplanning: Eliminating Transmissible HIV In Sex Transactions (AMETHIST) trial’s peer-led assessment of FSWs’ risk of HIV acquisition and transmission. We enrolled 60 participants (30 FSW and 30 peer microplanners) for semistructured in-depth interviews at 3 of 11 intervention sites. Interview guides and analysis were underpinned by three elements adapted from the UK Medical Research Council’s process evaluation framework: (1) feasibility, (2) acceptability and (3) fidelity. Using a framework analytic approach, data were familiarised, coded with NVivo V.12 software, charted, interpreted and then deductively mapped to these three elements. 

Results Peer microplanners used the risk scores to tailor their support to FSW with good fidelity. Some experienced difficulties completing assessments during the initial period of implementation. However, it was feasible for peer microplanners to establish strong relationships, and they used observational and conversational skills to elicit sensitive information from FSW to support their assessment. The assessments and tailored support offered by peer microplanners were acceptable to FSWs, although some did not appear to know they were being assessed. 

Conclusions Our findings show that peer microplanners feasibly and acceptably assessed FSW for certain risk factors through a scoring tool and focused their support accordingly. This approach could be integrated into other peer-led interventions to improve prioritisation of HIV programmes.