Department of Medicine, University of Washington, Seattle, WA.
HIV/STD Program, Public Health-Seattle & King County, Seattle, WA.
J Acquir Immune Defic Syndr. 2018 Aug 15;78(5):505-512. doi: 10.1097/QAI.0000000000001709.
Self-testing may increase HIV testing and decrease the time people with HIV are unaware of their status, but there is concern that absence of counseling may result in increased HIV risk.
Seattle, Washington.
We randomly assigned 230 high-risk HIV-negative men who have sex with men to have access to oral fluid HIV self-tests at no cost versus testing as usual for 15 months. The primary outcome was self-reported number of HIV tests during follow-up. To evaluate self-testing's impact on sexual behavior, we compared the following between arms: non-HIV-concordant condomless anal intercourse and number of male condomless anal intercourse partners in the last 3 months (measured at 9 and 15 months) and diagnosis with a bacterial sexually transmitted infection (STI: early syphilis, gonorrhea, and chlamydial infection) at the final study visit (15 months). A post hoc analysis compared the number of STI tests reported during follow-up.
Men randomized to self-testing reported significantly more HIV tests during follow-up (mean = 5.3, 95% confidence interval = 4.7 to 6.0) than those randomized to testing as usual (3.6, 3.2 to 4.0; P < 0.0001), representing an average increase of 1.7 tests per participant over 15 months. Men randomized to self-testing reported using an average of 3.9 self-tests. Self-testing was noninferior with respect to all markers of HIV risk. Men in the self-testing arm reported significantly fewer STI tests during follow-up (mean = 2.3, 95% confidence interval = 1.9 to 2.7) than men in the control arm (3.2, 2.8 to 3.6; P = 0.0038).
Access to free HIV self-testing increased testing frequency among high-risk men who have sex with men and did not impact sexual behavior or STI acquisition.
自我检测可能会增加艾滋病毒检测的次数，并减少艾滋病毒感染者不知道自己感染状况的时间，但人们担心，如果没有咨询服务，可能会增加艾滋病毒感染的风险。
华盛顿州西雅图。
我们随机分配 230 名高风险 HIV 阴性的男男性行为者，其中一组可以免费获得口腔液 HIV 自我检测，另一组则按照常规进行检测，为期 15 个月。主要结果是随访期间自我报告的 HIV 检测次数。为了评估自我检测对性行为的影响，我们比较了两组之间的以下情况：非 HIV 一致的无保护肛交和过去 3 个月中无保护的肛交性伴侣数（在第 9 个月和第 15 个月测量）以及在最后一次研究访问（15 个月）时诊断出的细菌性性传播感染（早期梅毒、淋病和衣原体感染）。事后分析比较了随访期间报告的性传播感染检测次数。
与常规检测组相比，接受自我检测的男性在随访期间报告的 HIV 检测次数明显更多（平均值=5.3，95%置信区间=4.7 至 6.0），这意味着每个参与者在 15 个月内平均增加了 1.7 次检测。接受自我检测的男性报告平均使用了 3.9 次自我检测。就所有 HIV 风险标志物而言，自我检测均不劣于常规检测。在自我检测组中，男性在随访期间报告的性传播感染检测次数明显少于对照组（平均值=2.3，95%置信区间=1.9 至 2.7）（P=0.0038）。
免费获得 HIV 自我检测增加了高风险男男性行为者的检测频率，且不会影响性行为或性传播感染的发生。
