van Rooyen Heidi, Tulloch Olivia, Mukoma Wanjiru, Makusha Tawanda, Chepuka Lignet, Knight Lucia C, Peck Roger B, Lim Jeanette M, Muturi Nelly, Chirwa Ellen, Taegtmeyer Miriam
Human Sciences Research Council, Durban, South Africa;
Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
J Int AIDS Soc. 2015 Mar 20;18(1):19445. doi: 10.7448/IAS.18.1.19445. eCollection 2015.
HIV self-testing (HIVST) has the potential to increase uptake of HIV testing among untested populations in sub-Saharan Africa and is on the brink of scale-up. However, it is unclear to what extent HIVST would be supported by stakeholders, what policy frameworks are in place and how variations between contexts might influence country-preparedness for scale-up. This qualitative study assessed the perceptions of HIVST among stakeholders in three sub-Saharan countries.
Fifty-four key informant interviews were conducted in Kenya (n=16), Malawi (n=26) and South Africa (n=12) with government policy makers, academics, activists, donors, procurement specialists, laboratory practitioners and health providers. A thematic analysis was conducted in each country and a common coding framework allowed for inter-country analysis to identify common and divergent themes across contexts.
Respondents welcomed the idea of an accurate, easy-to-use, rapid HIV self-test which could increase testing across all populations. High-risk groups, such as men, Men who have sex with men (MSM), couples and young people in particular, could be targeted through a range of health facility and community-based distribution points. HIVST is already endorsed in Kenya, and political support for scale-up exists in South Africa and Malawi. However, several caveats remain. Further research, policy and ensuing guidelines should consider how to regulate, market and distribute HIVST, ensure quality assurance of tests and human rights, and critically, link testing to appropriate support and treatment services. Low literacy levels in some target groups would also need context-specific consideration before scale up. World Health Organization (WHO) policy and regulatory frameworks are needed to guide the process in those areas which are new or specific to self-testing.
Stakeholders in three HIV endemic sub-Saharan countries felt that HIVST will be an important complement to existing community and facility-based testing approaches if accompanied by the same essential components of any HIV testing service, including access to accurate information and linkages to care. While there is an increasingly positive global policy environment regarding HIVST, several implementation and social challenges limit scale-up. There is a need for further research to provide contextual and operational evidence that addresses concerns and contributes to normative WHO guidance.
艾滋病毒自我检测（HIVST）有潜力提高撒哈拉以南非洲未检测人群的艾滋病毒检测率，并且正处于扩大规模的边缘。然而，目前尚不清楚利益相关者对HIVST的支持程度如何、现有的政策框架是什么，以及不同背景之间的差异可能如何影响各国扩大规模的准备情况。这项定性研究评估了撒哈拉以南三个国家的利益相关者对HIVST的看法。
在肯尼亚（n = 16）、马拉维（n = 26）和南非（n = 12），对政府政策制定者、学者、活动家、捐助者、采购专家、实验室从业人员和医疗服务提供者进行了54次关键信息访谈。在每个国家进行了主题分析，并采用了一个通用编码框架进行国家间分析，以确定不同背景下的共同主题和不同主题。
受访者对一种准确、易用、快速的艾滋病毒自我检测方法表示欢迎，这种检测方法可以提高所有人群的检测率。高风险群体，如男性、男男性行为者（MSM）、夫妇和年轻人等，可通过一系列医疗机构和社区分发点进行针对性检测。HIVST在肯尼亚已得到认可，南非和马拉维也存在扩大规模的政治支持。然而，仍有一些注意事项。进一步的研究、政策及后续指南应考虑如何对HIVST进行监管、营销和分发，确保检测的质量保证和人权，并且至关重要的是，将检测与适当的支持和治疗服务相联系。在扩大规模之前，还需要针对一些目标群体识字水平较低的情况进行因地制宜的考虑。需要世界卫生组织（WHO）的政策和监管框架来指导那些针对自我检测的新领域或特定领域的进程。
撒哈拉以南三个艾滋病毒流行国家的利益相关者认为，如果HIVST具备任何艾滋病毒检测服务的相同基本要素，包括获取准确信息和与护理的联系，那么它将是现有基于社区和医疗机构检测方法的重要补充。虽然全球对HIVST的政策环境日益积极，但一些实施和社会挑战限制了其扩大规模。需要进一步研究，以提供背景和操作证据，解决相关问题并为WHO的规范性指导做出贡献。
