Infectious Diseases institute, College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda.
Clarke International University, Kampala, Uganda.
J Int AIDS Soc. 2019 Mar;22(3):e25269. doi: 10.1002/jia2.25269.
HIV self-testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the acceptability, perceived reliability and challenges associated with distributing HIV self-test (HIVST) to young men who have sex with men (MSM) in Uganda.
Between February and May, 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management.
MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non-painful; and non-stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop-in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services.
Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow-up, linkage to HIV care and prevention services are needed for effective results.
HIV 自我检测是一种灵活、可及且可接受的新兴技术，尤其有可能发现那些不愿意接受传统 HIV 检测方法的 HIV 感染者。我们评估了在乌干达向男男性行为者（MSM）分发 HIV 自我检测（HIVST）的可接受性、感知可靠性和相关挑战。
2018 年 2 月至 5 月，我们有目的的招募了 74 名年龄在 18 岁及以上的 MSM，并通过口头同意参与了在艾滋病支持组织（TASO 马萨卡和恩德培）进行的 6 次焦点小组讨论（FGD）。我们还对 18 名卫生工作者进行了 2 次 FGD。MSM FGD 小组包括以下几类参与者：（1）一年前以上接受过检测；（2）在过去六个月至一年前接受过检测；（3）在过去三至六个月前接受过检测；（4）从未接受过检测。FGD 探讨了：（i）HIVST 分发的可接受性；（ii）对各种 HIVST 分发渠道的偏好；（iii）对 HIVST 准确性的看法；（iv）HIVST 分发相关的挑战。我们确定了主要主题，制定并完善了一个代码本。我们使用 Nvivo 版本 11 进行数据管理。
MSM 参与者的年龄在 19 至 30 岁之间。参与者将 HIVST 描述为一种机制，能够以快速、高效、保密、无痛苦和非污名化的方式促进 HIV 检测。总体而言，MSM 更喜欢 HIVST 而不是传统的 HIV 检测方法。卫生工作者支持通过 MSM 同行分发 HIVST 工具包。MSM 参与者愿意分发工具包，并向他们的同行和性伴侣推荐 HIVST。他们建议 HIVST 工具包分发模型类似于艾滋病支持组织目前正在实施的避孕套和润滑剂同伴模式。首选的渠道是同伴、热点、上门服务中心、私人药店和对 MSM 友好的医疗设施。关于使用 HIVST 的主要关注点包括：HIVST 结果不可靠、阳性结果导致的社会危害、需要进行确认性检测以及将 HIV 阳性和阴性参与者都联系起来以获得额外的 HIV 服务。
由 MSM 同伴分发 HIVST 工具包是一种可以促进检测的可接受策略。参与者认为 HIVST 是有益的，因为它将解决许多影响他们接受检测的障碍。然而，需要采取一种结合后续行动、与 HIV 护理和预防服务联系的综合方法，以获得有效的结果。
