Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
PLoS One. 2017 Nov 17;12(11):e0187998. doi: 10.1371/journal.pone.0187998. eCollection 2017.
INTRODUCTION: HIV self-testing (HIVST) is a novel approach designed to assist in achieving the goal of at least 90% of the population that learn their HIV status. A self-test user with a positive test is required to visit a clinic to link into HIV care, yet little is known about patient preferences for linkage strategies. We examined the intention to link to care amongst potential HIVST users and the suitability of three linkage to care strategies in Lusaka Province, Zambia. METHODS: We conducted a representative cross sectional survey of 1,617 individuals aged 16-49 years old in Lusaka Province. Participants were shown a video of the HIVST. Data on intention to link to care and preferred linkage to care strategies-text message, phone call and home visits were collected. Eight focus group discussions were held concurrently with survey respondents to understand their preferences between the three linkage to care strategies. RESULTS: Of 1617 enrolled, 60% were women, 40% were men, with an average age of 27years (IQR = 22, 35). More men than women had at least secondary education (84% vs 77%) and were either employed or self-employed (67% vs. 41%). 85% (95%CI = 83 to 86) of participants said they would link to care within the first week of a positive self-test. Income >2,000 Kwacha (USD 200) per month versus income < 2,000 Kwacha (Adjusted odds ratio (AOR) = 0.59; 95%CI: 0.40 to 0.88; p = 0.009) and never versus prior HIV testers (AOR = 0.54; 95%CI: 0.32 to 0.91; p = 0.020) were associated with reduced odds of intention to link to care. 53% (95%CI = 50 to 55) preferred being prompted to link to care by home visits compared to phone call (30%) or SMS (17%). CONCLUSION: We found almost nine out of ten potential HIVST users in the general population intend to link to care shortly after a positive test, and preferred home visits or phone calls to facilitate linkage, rather than SMS. Also, higher income earners and those who never tested for HIV were associated with reduced odds of intention to link to care. Policy guidelines and implementation strategies for HIVST should be responsive to patient preferences for linkage to care strategies to achieve the continuum of HIV care.
简介：HIV 自我检测（HIVST）是一种新方法，旨在帮助实现至少 90%的人群了解其 HIV 状况的目标。自我检测呈阳性的患者需要到诊所进行检测，以与 HIV 护理联系起来，但对于患者对联系策略的偏好知之甚少。我们研究了潜在 HIVST 用户联系护理的意愿，以及在赞比亚卢萨卡省三种联系护理策略的适宜性。 方法：我们对卢萨卡省 1617 名 16-49 岁的成年人进行了一项代表性的横断面调查。参与者观看了 HIVST 的视频。收集了与联系护理意愿和首选联系护理策略（短信、电话和家访）的数据。同时进行了 8 次焦点小组讨论，以了解参与者对这三种联系护理策略的偏好。 结果：在 1617 名参与者中，60%为女性，40%为男性，平均年龄为 27 岁（IQR=22，35）。与女性相比，更多的男性接受过至少中等教育（84%对 77%），要么有工作，要么是自雇（67%对 41%）。85%（95%CI=83 到 86）的参与者表示，如果 HIV 自我检测呈阳性，他们将在第一周内联系护理。收入>2000 克瓦查（200 美元）/月与收入<2000 克瓦查（调整后的优势比（AOR）=0.59；95%CI：0.40 至 0.88；p=0.009）和从未接受过 HIV 检测者（AOR=0.54；95%CI：0.32 至 0.91；p=0.020）与联系护理意愿降低相关。53%（95%CI=50 到 55）更喜欢通过家访而不是电话（30%）或短信（17%）来提示联系护理。 结论：我们发现，一般人群中近十分之九的潜在 HIVST 用户在检测呈阳性后不久就打算联系护理，他们更喜欢通过家访或电话来促进联系，而不是短信。此外，收入较高者和从未接受过 HIV 检测者与联系护理意愿降低相关。HIVST 的政策指南和实施策略应响应患者对联系护理策略的偏好，以实现 HIV 护理的连续体。
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