Flowers Paul, Estcourt Claudia, Sonnenberg Pam, Burns Fiona
Institute for Applied Health Research, Glasgow Caledonian University, Scotland G4 OBA, UK.
Research Department of Infection and Population Health, University College London, WC1E 6JB, UK.
Sex Health. 2017 Feb;14(1):80-88. doi: 10.1071/SH16081.
HIV testing is a 'gateway' technology, enabling access to treatment and HIV prevention. Biomedical approaches to prevention, such as pre-exposure prophylaxis and treatment as prevention, require accurate and regular HIV test results. HIV testing also represents a powerful 'teachable moment' for behavioural prevention. An increasing range of HIV tests and the emergence of self-managed diagnostic technologies (e.g. self-testing) means there is now considerable diversification of when, where and how results are available to those who test. These changes have profound implications for intervention development and, indeed, health service redesign. This paper highlights the need for better ways of conceptualising testing in order to capitalise on the health benefits that diverse HIV testing interventions will bring. A multidimensional framework is proposed to capture ongoing developments in HIV testing among men who have sex with men and focus on the intersection of: (1) the growing variety of HIV testing technologies and the associated diversification of their pathways into care; (2) psychosocial insights into the behavioural domain of HIV testing; and (3) better appreciation of population factors associated with heterogeneity and concomitant inequities. By considering these three aspects of HIV testing in parallel, it is possible to identify gaps, limitations and opportunities in future HIV testing-related interventions. Moreover, it is possible to explore and map how diverse interventions may work together having additive effects. Only a holistic and dynamic framework that captures the increasing complexity of HIV testing is fit for purpose to deliver the maximum public health benefit of HIV testing.
艾滋病毒检测是一项“入门”技术，能让人获得治疗并预防艾滋病毒。生物医学预防方法，如暴露前预防和治疗即预防，需要准确且定期的艾滋病毒检测结果。艾滋病毒检测对于行为预防而言也是一个有力的“可教育时机”。艾滋病毒检测种类日益增多，自我管理诊断技术（如自我检测）不断涌现，这意味着现在接受检测者获取检测结果的时间、地点和方式有了相当大的多样化。这些变化对干预措施的制定乃至卫生服务的重新设计都有着深远影响。本文强调需要有更好的方式来对检测进行概念化，以便利用各种艾滋病毒检测干预措施带来的健康益处。本文提出了一个多维框架，以把握男男性行为者中艾滋病毒检测的持续发展情况，并关注以下几个方面的交叉点：（1）艾滋病毒检测技术种类不断增加及其进入医疗体系途径的相应多样化；（2）对艾滋病毒检测行为领域的社会心理洞察；（3）更好地认识与异质性及随之而来的不平等相关的人群因素。通过同时考虑艾滋病毒检测的这三个方面，就有可能确定未来与艾滋病毒检测相关干预措施中的差距、局限性和机会。此外，还可以探索并描绘各种干预措施如何协同发挥累加效应。只有一个能把握艾滋病毒检测日益复杂情况的全面且动态的框架，才适合实现艾滋病毒检测的最大公共卫生效益。
