Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lancet HIV. 2016 Jun;3(6):e266-74. doi: 10.1016/S2352-3018(16)00041-2. Epub 2016 Apr 8.
BACKGROUND: Increased uptake of HIV testing by men in sub-Saharan Africa is essential for the success of combination prevention. Self-testing is an emerging approach with high acceptability, but little evidence exists on the best strategies for test distribution. We assessed an approach of providing multiple self-tests to women at high risk of HIV acquisition to promote partner HIV testing and to facilitate safer sexual decision making. METHODS: In this cohort study, HIV-negative women aged 18-39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal and post-partum clinics and a drop-in centre for female sex workers. Participants gave informed consent and were instructed on use of oral fluid based rapid HIV tests. Participants enrolled at the health facility received three self-tests and those at the drop-in centre received five self-tests. Structured interviews were conducted with participants at enrolment and over 3 months to determine how self-tests were used. Outcomes included the number of self-tests distributed by participants, the proportion of participants whose sexual partners used a self-test, couples testing, and sexual behaviour after self-testing. FINDINGS: Between Jan 14, 2015, and March 13, 2015, 280 participants were enrolled (61 in antenatal care, 117 in post-partum care, and 102 female sex workers); follow-up interviews were completed for 265 (96%). Most participants with primary sexual partners distributed self-tests to partners: 53 (91%) of 58 participants in antenatal care, 91 (86%) of 106 in post-partum care, and 64 (75%) of 85 female sex workers. 82 (81%) of 101 female sex workers distributed more than one self-test to commercial sex clients. Among self-tests distributed to and used by primary sexual partners of participants, couples testing occurred in 27 (51%) of 53 in antenatal care, 62 (68%) of 91 from post-partum care, and 53 (83%) of 64 female sex workers. Among tests received by primary and non-primary sexual partners, two (4%) of 53 tests from participants in antenatal care, two (2%) of 91 in post-partum care, and 41 (14%) of 298 from female sex workers had positive results. Participants reported sexual intercourse with 235 (62%) of 380 sexual partners who tested HIV-negative, compared with eight (18%) of 45 who tested HIV-positive (p<0·0001); condoms were used in all eight intercourse events after positive results compared with 104 (44%) after of negative results (p<0·0018). Four participants reported intimate partner violence as a result of self-test distribution: two in the post-partum care group and two female sex workers. No other adverse events were reported. INTERPRETATION: Provision of multiple HIV self-tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop self-testing policies and programmes. FUNDING: Bill & Melinda Gates Foundation.
背景：撒哈拉以南非洲地区男性接受艾滋病病毒检测人数的增加对于组合预防的成功至关重要。自我检测是一种接受度很高的新兴方法，但关于最佳检测分发策略的证据很少。我们评估了一种向有高感染艾滋病毒风险的妇女提供多个自我检测的方法，以促进伴侣进行艾滋病毒检测并促进更安全的性行为决策。
方法：在这项队列研究中，我们在肯尼亚基苏木的两个地点招募了 18-39 岁的 HIV 阴性妇女：一个是有产前和产后诊所的卫生机构，另一个是女性性工作者的临时咨询中心。参与者在知情同意后，接受了口腔液快速 HIV 检测的指导。在卫生机构登记的参与者收到了三个自我检测，而在临时咨询中心登记的参与者收到了五个自我检测。在登记时和 3 个月内对参与者进行了结构性访谈，以确定自我检测的使用情况。结果包括参与者分发的自我检测数量、参与者性伴侣使用自我检测的比例、夫妇检测以及自我检测后的性行为。
发现：2015 年 1 月 14 日至 2015 年 3 月 13 日期间，共招募了 280 名参与者（61 名在产前护理，117 名在产后护理，102 名女性性工作者）；对 265 名（96%）参与者完成了随访访谈。大多数有主要性伴侣的参与者将自我检测分发给了伴侣：61 名产前护理中的 58 名参与者（91%）、106 名产后护理中的 91 名参与者（86%）和 85 名女性性工作者中的 64 名参与者（75%）。101 名女性性工作者中的 82 名（81%）将多个自我检测分发给了商业性性伴侣。在参与者的主要性伴侣中分发并使用的自我检测中，53 名产前护理中的 27 名参与者（51%）、91 名产后护理中的 62 名参与者（68%）和 64 名女性性工作者中的 53 名参与者（83%）进行了夫妇检测。在收到的主要和非主要性伴侣的检测中，53 名产前护理中的 2 名参与者（4%）、91 名产后护理中的 2 名参与者（2%）和 298 名女性性工作者中的 41 名参与者（14%）的检测结果呈阳性。参与者报告与 235 名 HIV 阴性性伴侣发生了性行为（380 名性伴侣的 62%），而与 45 名 HIV 阳性性伴侣发生了 8 次性行为（18%）（p<0·0001）；在阳性结果后，参与者报告在所有 8 次性接触中都使用了避孕套，而在阴性结果后，避孕套的使用比例为 104 次（44%）（p<0·0018）。有 4 名参与者报告说，由于自我检测的分发，他们遭受了亲密伴侣的暴力：2 名在产后护理组，2 名女性性工作者。没有报告其他不良事件。
解释：向有高感染艾滋病毒风险的妇女提供多个艾滋病毒自我检测，成功地促进了她们性伴侣的艾滋病毒检测，并促进了更安全的性行为决策。作为各国制定自我检测政策和方案的考虑因素，这种新策略值得进一步考虑。
资金来源：比尔及梅琳达·盖茨基金会。
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