DISCUSSION
RECRUITMENT
This qualitative study of TGW enrolled in a cluster randomized trial in Kampala, Uganda, suggests that peer delivery of HIV self‐tests, self‐collection of samples for STI testing and PrEP motivated prevention uptake. Peer support for HIV/STI testing and PrEP adherence was valued by study participants who, in turn, reached out to TGW not engaged in care, taught them about HIVST and encouraged them to take PrEP. HIVST with intimate partners strengthened partnered relationships, but PrEP taking after mutual disclosure of HIV‐negative status aroused suspicions of infidelity. Self‐sampling for STI testing was novel and empowering because it afforded privacy and confidentiality. TGW valued STI testing and treatment as improving their quality of life. Overall, peer services were experienced as extending beyond the provision of HIV prevention commodities, to caring for health and wellbeing by providing psychosocial support and stigma coping strategies as well as facilitating community connectedness.To our knowledge, this is the first qualitative evaluation of peer‐delivered HIVST, STISS and PrEP for TGW in any setting. As anticipated, TGW peers in our randomized trial acted as recruitment facilitators, health system navigators and intervention deliverers to support prevention uptake by TGW [Self‐sampling for etiological diagnosis of CT and NG was empowering for this sample of TGW. They desired to avoid the embarrassment of exposing their bodies during sample collection at the research clinic. Thus, self‐sampling at home and confidentiality of test results were preferred. Other qualitative research has found that self‐collection of samples is acceptable for TGW in multiple settings [HIV self‐tests facilitated mutual partner testing, status disclosure and sexual decision‐making in this sample of TGW. TGW initiated partner testing by asking their partner to self‐test or offering to test them. HIVST is the preferred testing modality of TGW because of its confidentiality and convenience [The strengths of our study include the first qualitative evaluation of peer‐delivered HIV self‐tests and STI self‐sampling kits as facilitators of oral PrEP adherence for TGW. We interviewed participants, partners and peers to include multiple perspectives of intervention delivery. The qualitative data enable a detailed understanding of intervention experiences, strengths and drawbacks. One of the authors identifies as transgender, which aided our interpretation of the data. Additionally, we involved transgender colleagues in various aspects, such as reviewing data collection instruments, recruiting and retaining participants, delivering the intervention, reviewing the manuscript and disseminating the results. The limitations of this work include the clinical trial setting, which may not reflect “real world” implementation of HIVST, STISS and PrEP where peer delivery of these interventions is not routine. Like all qualitative research studies, our findings are not, and should not be construed as generalizable. However, they may inform peer delivery of HIV prevention interventions in other African settings.