Anova Health Institute, Johannesburg, South Africa; and Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, CA, USA.
S Afr Med J. 2019 Mar 29;109(4):227-231. doi: 10.7196/SAMJ.2019.v109i4.13818.
Current research suggests that HIV self-screening (HIVSS) is a feasible and acceptable approach to increase HIV testing among men who have sex with men (MSM). However, few data are available to shape policy around dissemination and implementation. Gaps in knowledge include preferences for distribution of HIVSS kits, potential social harms and benefits of their use, and how much test users would be willing to pay for the kits. The aim was to inform policy recommendations to optimise distribution of HIVSS kits to MSM in South Africa (SA), where there is a high HIV incidence and unmet testing needs. MSM in the high-HIV-prevalence Gert Sibande and Ehlanzeni districts of Mpumalanga Province, SA, were enrolled between October 2015 and May 2017. Participants were provided with their choice of blood or oral fluid HIVSS test kits, receiving 5 kits at enrolment and 4 additional kits at the 3-month follow-up visit. Questionnaires were administered at enrolment, 3 months and 6 months. We analysed participants' reported social benefits and harms, and their preferences for kit distribution and pricing. Among 127 MSM screened and enrolled, 114 responded to follow-up questionnaires regarding distribution preferences, 49.3% preferred to acquire HIVSS kits at a community-based organisation (CBO) and 42.7% at a clinic, with 8% preferring a pharmacy. Participants with higher education preferred CBO sites for distribution; in other respects preferences were similar by demographic characteristics. Reported social benefits were common, including knowing one's status, prevention knowledge gained and improved communication with partners. Despite ubiquitous interest in using the kits, the majority of MSM could not afford to purchase test kits. SA guidelines have integrated HIVSS into HIV and testing policy, but little has been published regarding distribution channels of the kits for MSM and other key populations. There is a partnership between the National Department of Health and CBOs that specialise in key population programming to ensure MSM and other populations with unmet testing needs can access affordable test kits. We observed no social harms, and there were multiple social benefits. Consequently, we recommend immediate free or low-cost distribution of HIVSS kits to MSM through community-based initiatives. Future research should continue to assess optimised linkage to care.
目前的研究表明，艾滋病毒自我筛查（HIVSS）是一种增加男男性行为者（MSM）艾滋病毒检测的可行且可接受的方法。然而，目前的数据还不足以制定传播和实施方面的政策。知识空白包括对 HIVSS 试剂盒分发的偏好、使用它们的潜在社会危害和益处，以及测试用户愿意为试剂盒支付多少费用。其目的是为南非（SA）向 MSM 分发 HIVSS 试剂盒提供政策建议，因为南非 HIV 发病率高且检测需求未得到满足。2015 年 10 月至 2017 年 5 月期间，在南非姆普马兰加省高艾滋病毒流行的格特西班德和埃兰泽尼地区招募了 MSM。参与者可以选择血液或口腔液 HIVSS 检测试剂盒，在入组时收到 5 个试剂盒，并在 3 个月的随访时收到 4 个额外的试剂盒。在入组时、3 个月和 6 个月时进行问卷调查。我们分析了参与者报告的社会收益和危害，以及他们对试剂盒分发和定价的偏好。在筛查和入组的 127 名 MSM 中，有 114 名对分发偏好做出了回应，49.3%的人更喜欢在社区组织（CBO）获得 HIVSS 试剂盒，42.7%的人更喜欢在诊所获得，8%的人更喜欢在药店获得。受教育程度较高的参与者更喜欢在 CBO 站点分发；在其他方面，偏好因人口特征而异。常见的社会收益包括了解自己的状况、获得预防知识和改善与伴侣的沟通。尽管大多数 MSM 都普遍有兴趣使用这些试剂盒，但他们中的大多数人都买不起测试试剂盒。南非的指南已经将 HIVSS 纳入了艾滋病毒和检测政策，但关于 MSM 和其他重点人群的试剂盒分发渠道几乎没有发表。国家卫生部和专门从事重点人群规划的社区组织之间存在伙伴关系，以确保 MSM 和其他有未满足检测需求的人群能够获得负担得起的测试套件。我们没有观察到任何社会危害，而且有多种社会收益。因此，我们建议立即通过社区举措免费或低成本向 MSM 分发 HIVSS 试剂盒。未来的研究应继续评估优化与护理的联系。
