Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America.
Anova Health Institute, Johannesburg, South Africa.
PLoS One. 2018 Nov 8;13(11):e0206849. doi: 10.1371/journal.pone.0206849. eCollection 2018.
BACKGROUND: HIV self-testing (HIVST) may increase HIV testing uptake, facilitating earlier treatment for key populations like MSM who experience barriers accessing clinic-based HIV testing. HIVST usability among African MSM has not been explored. METHODS: We assessed usability of oral fluid (OF) and fingerstick (FS; blood) HIVST kits during three phases among MSM with differing degrees of HIVST familiarity in Mpumalanga, South Africa. In 2015, 24 HIVST-naïve MSM conducted counselor-observed OF and FS HIVST after brief demonstration. In 2016 and 2017, 45 and 64 MSM with experience using HIVST in a pilot study chose one HIVST to conduct with a counselor-observer present. In addition to written, the latter group had access to video instructions. We assessed frequency of user errors and reported test use ease, changes in error frequency by phase, and covariates associated with correct usage using log-Poisson and Gaussian generalized estimating equations. RESULTS: Among OF users (n = 57), 15-30% committed errors in each phase; however, observers consistently rated participants as able to test alone. Among FS users (n = 100), observers noted frequent errors, most commonly related to blood collection and delivery. We found suggestive evidence (not reaching statistical significance) that user errors decreased, with 37.5%, to 28.1%, and 18.2% committing errors in phases I, II, and III, respectively (p-value:0.08), however observer concerns remained constant. Ease and confidence using HIVST increased with HIV testing experience. Participants using three HIVST were more likely (RR:1.92, 95% CI:1.32, 2.80) to report ease compared to those without prior HIVST experience. Never testers (RR:0.66, 95% CI:0.44-0.99) reported less ease performing HIVST compared to participants testing in the past six months. CONCLUSIONS: MSM were able to perform the OF test. Fingerstick test performance was less consistent; however preference for fingerstick was strong and performance may improve with exposure and instructional resources. Continued efforts to provide accessible instructions are paramount.
背景：HIV 自我检测（HIVST）可能会增加 HIV 检测的采用率，为男男性行为者等关键人群提供便利，这些人群在接受诊所 HIV 检测方面存在障碍。尚未探讨非洲男男性行为者对 HIVST 的可用性。
方法：我们在南非姆普马兰加省对不同程度熟悉 HIVST 的男男性行为者进行了三个阶段的研究，评估了口腔液（OF）和指尖（FS；血液）HIVST 试剂盒的可用性。在 2015 年，24 名 HIVST 初筛的男男性行为者在经过短暂演示后进行了有顾问观察的 OF 和 FS HIVST。在 2016 年和 2017 年，45 名和 64 名在试点研究中使用过 HIVST 的男男性行为者选择了一种 HIVST，并由顾问观察进行。除了书面说明外，后一组还可以访问视频说明。我们评估了用户错误的频率，并报告了测试的易用性，通过阶段变化的错误频率，以及与正确使用相关的协变量，使用对数泊松和高斯广义估计方程。
结果：在 OF 用户（n = 57）中，每个阶段有 15-30%的人犯错误；然而，观察员一致认为参与者能够独自进行测试。在 FS 用户（n = 100）中，观察员注意到经常出现错误，最常见的是与血液采集和输送有关。我们发现了一些提示性证据（未达到统计学意义），即用户错误减少，第一阶段、第二阶段和第三阶段分别有 37.5%、28.1%和 18.2%的人犯错误（p 值：0.08），然而观察员的担忧仍然不变。随着 HIV 检测经验的增加，使用 HIVST 的易用性和信心也会增加。与没有 HIVST 经验的参与者相比，使用三种 HIVST 的参与者更有可能（RR：1.92，95%CI：1.32，2.80）报告易用性。从未接受过 HIVST 的参与者（RR：0.66，95%CI：0.44-0.99）报告的 HIVST 易用性低于过去六个月接受过 HIVST 的参与者。
结论：男男性行为者能够进行 OF 测试。指尖测试的表现不太一致；然而，对手指测试的偏好很强，随着接触和教学资源的增加，表现可能会有所改善。继续努力提供易于访问的说明至关重要。
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