Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon.
Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo.
PLoS One. 2019 Jul 1;14(7):e0218795. doi: 10.1371/journal.pone.0218795. eCollection 2019.
BACKGROUND: Adolescents living in sub-Saharan Africa constitute a vulnerable population at significant risk of HIV infection. This study aims to evaluate the acceptability, feasibility, and accuracy of home-based, supervised HIV self-testing (HIVST) as well as their predictors among adolescents living in Kisangani, Democratic Republic of the Congo (DRC). METHODS: A cross-sectional, door-to-door survey using a blood-based HIV self-test and a peer-based supervised HIVST approach was conducted from July to August 2018 in Kisangani, DRC. The acceptability and feasibility of HIVST were assessed among adolescents' consenting to use and interpret HIV self-test. The accuracy of HIVST was estimated by the sensibility and specificity of adolescent-interpreted HIV self-test. Factors associated with acceptability and feasibility of HIVST were analyzed with logistic regression. RESULTS: A total of 628 adolescents (including 369 [58.8%] females) aged between 15 and 19 years were enrolled. Acceptability of HIVST was high (95.1%); 96.1% of participants correctly used the self-test, and 65.2% asked for verbal instructions. The majority of adolescents (93.5%) correctly interpreted their self-test results. The Cohen's κ coefficient between the results read by adolescents and by supervisors was 0.62. The correct interpretation decreased significantly when adolescents had no formal education or attended primary school as compared to those currently attending university (37.0% versus 100%; adjusted OR: 0.01 [95% CI: 0.004-0.03]). In the hands of adolescents at home, the sensitivity of the Exacto Test HIV Self-test was estimated at 100%, while its specificity was 96.0%. The majority of participants (68.0%) affirmed that post-test counseling was essential, and that face-to-face counseling (78.9%) was greatly preferred. CONCLUSIONS: Home-based, supervised HIVST using a blood-based self-test and peer-based approach can be used with a high degree of acceptability and feasibility by adolescents living in Kisangani, DRC. Misinterpretation of test results is challenging to obtaining good feasibility of HIVST among adolescents with poor educational level. Face-to-face post-test counseling seems to be preferred among Kisangani's adolescents.
背景：撒哈拉以南非洲的青少年是一个易感染艾滋病毒的脆弱群体。本研究旨在评估在刚果民主共和国金沙萨，基于家庭、监督的艾滋病毒自我检测（HIVST）的可接受性、可行性和准确性，以及其预测因素。
方法：2018 年 7 月至 8 月，在金沙萨进行了一项基于横断面、挨家挨户的调查，使用了一种基于血液的 HIV 自我检测和一种基于同伴的监督 HIVST 方法。对同意使用和解释 HIV 自我检测的青少年进行了 HIVST 的可接受性和可行性评估。通过青少年解释的 HIV 自我检测的敏感性和特异性来估计 HIVST 的准确性。采用逻辑回归分析与 HIVST 的可接受性和可行性相关的因素。
结果：共纳入 628 名 15 至 19 岁的青少年（包括 369 名[58.8%]女性）。HIVST 的可接受性很高（95.1%）；96.1%的参与者正确使用了自我检测，65.2%的人要求口头指导。大多数青少年（93.5%）正确解释了他们的自我检测结果。青少年和监督员读取结果之间的 Cohen's κ 系数为 0.62。与正在上大学的青少年相比，没有正规教育或上小学的青少年正确解释结果的比例显著下降（37.0%对 100%；调整后的 OR：0.01[95%CI：0.004-0.03]）。在青少年手中，Exacto Test HIV Self-test 的灵敏度估计为 100%，特异性为 96.0%。大多数参与者（68.0%）认为检测后咨询是必要的，面对面咨询（78.9%）是他们最希望的咨询方式。
结论：在刚果民主共和国金沙萨，使用基于血液的自我检测和基于同伴的方法进行家庭监督的 HIVST 具有高度的可接受性和可行性。在教育程度较低的青少年中，对检测结果的误解对获得良好的 HIVST 可行性构成挑战。面对面的检测后咨询似乎是金沙萨青少年的首选。
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