Sarkar Archana, Mburu Gitau, Shivkumar Poonam Varma, Sharma Pankhuri, Campbell Fiona, Behera Jagannath, Dargan Ritu, Mishra Surendra Kumar, Mehra Sunil
Research, Innovations, and Monitoring Unit, MAMTA Health Institute for Mother & Child, New Delhi, India;
Program Impact Unit, International HIV/AIDS Alliance, East Sussex, UK.
J Int AIDS Soc. 2016 Sep 12;19(1):20993. doi: 10.7448/IAS.19.1.20993. eCollection 2016.
HIV self-testing can increase coverage of essential HIV services. This study aimed to establish the acceptability, concordance and feasibility of supervised HIV self-testing among pregnant women in rural India.
A cross-sectional, mixed methods study was conducted among 202 consenting pregnant women in a rural Indian hospital between August 2014 and January 2015. Participants were provided with instructions on how to self-test using OraQuick(®) HIV antibody test, and subsequently asked to self-test under supervision of a community health worker. Test results were confirmed at a government-run integrated counselling and testing centre. A questionnaire was used to obtain information on patient demographics and the ease, acceptability and difficulties of self-testing. In-depth interviews were conducted with a sub-sample of 35 participants to understand their experiences.
In total, 202 participants performed the non-invasive, oral fluid-based, rapid test under supervision for HIV screening. Acceptance rate was 100%. Motivators for self-testing included: ease of testing (43.4%), quick results (27.3%) and non-invasive procedure (23.2%). Sensitivity and specificity were 100% for 201 tests, and one test was invalid. Concordance of test result interpretation between community health workers and participants was 98.5% with a Cohen's Kappa (k) value of k=0.566 with p<0.001 for inter-rater agreement. Although 92.6% participants reported that the instructions for the test were easy to understand, 18.7% required the assistance of a supervisor to self-test. Major themes that emerged from the qualitative interviews indicated the importance of the following factors in influencing acceptability of self-testing: clarity and accessibility of test instructions; time-efficiency and convenience of testing; non-invasiveness of the test; and fear of incorrect results. Overall, 96.5% of the participants recommended that the OraQuick(®) test kits should become publicly available.
Self-testing for HIV status using an oral fluid-based rapid test under the supervision of a community health worker was acceptable and feasible among pregnant women in rural India. Participants were supportive of making self-testing publicly available. Policy guidelines and implementation research are required to advance HIV self-testing for larger populations at scale.
艾滋病毒自我检测可提高基本艾滋病毒服务的覆盖范围。本研究旨在确定印度农村地区孕妇接受监督的艾滋病毒自我检测的可接受性、一致性和可行性。
2014年8月至2015年1月期间，在印度一家农村医院对202名同意参与的孕妇进行了一项横断面混合方法研究。向参与者提供了如何使用奥芮可（®）艾滋病毒抗体检测进行自我检测的说明，随后要求她们在社区卫生工作者的监督下进行自我检测。检测结果在政府运营的综合咨询和检测中心得到确认。使用问卷调查获取患者人口统计学信息以及自我检测的难易程度、可接受性和困难情况。对35名参与者的子样本进行了深入访谈，以了解她们的经历。
共有202名参与者在监督下进行了非侵入性的基于口腔液的快速艾滋病毒筛查检测。接受率为100%。自我检测的动机包括：检测简便（43.4%）、结果快速（27.3%）和检测非侵入性（23.2%）。201次检测的灵敏度和特异性均为100%，一次检测无效。社区卫生工作者与参与者之间检测结果解读的一致性为98.5%，科恩kappa（k）值为k = 0.566，评分者间一致性p < 0.001。尽管92.6%的参与者表示检测说明易于理解，但18.7%的人在自我检测时需要监督人员的协助。定性访谈中出现的主要主题表明，以下因素对影响自我检测的可接受性很重要：检测说明的清晰度和可获取性；检测的时间效率和便利性；检测的非侵入性；以及对错误结果的担忧。总体而言，96.5%的参与者建议奥芮可（®）检测试剂盒应公开提供。
在印度农村地区的孕妇中，在社区卫生工作者的监督下使用基于口腔液的快速检测进行艾滋病毒状态自我检测是可接受且可行的。参与者支持公开提供自我检测服务。需要政策指南和实施研究，以便为更多人群大规模推进艾滋病毒自我检测。
