PT - JOURNAL ARTICLE AU - Catherine E Oldenburg AU - Katrina F Ortblad AU - Michael M Chanda AU - Kalasa Mwanda AU - Wendy Nicodemus AU - Rebecca Sikaundi AU - Andrew Fullem AU - Leah G Barresi AU - Guy Harling AU - Till Bärnighausen TI - 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 AID - 10.1136/bmjopen-2016-014780 DP - 2017 Apr 01 TA - BMJ Open PG - e014780 VI - 7 IP - 4 4099 - http://bmjopen.bmj.com/content/7/4/e014780.short 4100 - http://bmjopen.bmj.com/content/7/4/e014780.full SO - BMJ Open2017 Apr 01; 7 AB - Background HIV testing and knowledge of status are starting points for HIV treatment and prevention interventions. Among female sex workers (FSWs), HIV testing and status knowledge remain far from universal. HIV self-testing (HIVST) is an alternative to existing testing services for FSWs, but little evidence exists how it can be effectively and safely implemented. Here, we describe the rationale and design of a cluster randomised trial designed to inform implementation and scale-up of HIVST programmes for FSWs in Zambia.Methods The Zambian Peer Educators for HIV Self-Testing (ZEST) study is a 3-arm cluster randomised trial taking place in 3 towns in Zambia. Participants (N=900) are eligible if they are women who have exchanged sex for money or goods in the previous 1 month, are HIV negative or status unknown, have not tested for HIV in the previous 3 months, and are at least 18 years old. Participants are recruited by peer educators working in their communities. Participants are randomised to 1 of 3 arms: (1) direct distribution (in which they receive an HIVST from the peer educator directly); (2) fixed distribution (in which they receive a coupon with which to collect the HIVST from a drug store or health post) or (3) standard of care (referral to existing HIV testing services only, without any offer of HIVST). Participants are followed at 1 and 4 months following distribution of the first HIVST. The primary end point is HIV testing in the past month measured at the 1-month and 4-month visits.Ethics and dissemination This study was approved by the Institutional Review Boards at the Harvard T.H. Chan School of Public Health in Boston, USA and ERES Converge in Lusaka, Zambia. The findings of this trial will be presented at local, regional and international meetings and submitted to peer-reviewed journals for publication.Trial registration number Pre-results; NCT02827240.