Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Society for Family Health, Johannesburg, South Africa.
BMC Public Health. 2019 Jul 8;19(1):898. doi: 10.1186/s12889-019-7122-5.
BACKGROUND: HIV diagnosis is a critical step in linking HIV-infected individuals to care and treatment and linking HIV-uninfected persons to prevention services. However, the uptake of HIV testing remains low in many countries. HIV self-screening (HIVSS) is acceptable to adults, but there is limited data on HIVSS feasibility in community programmes. This study aimed to evaluate the feasibility of HIVSS in South Africa. METHODS: We conducted a prospective study that enrolled participants through mobile site, homebased, workplace and sex worker programmes in two townships from May to November 2017. Following an information session on HIVSS, interested participants were offered one of three methods of HIVSS testing: supervised, semi-supervised, and unsupervised. Participants who opted for unsupervised testing and those who tested HIV positive after semi- or supervised HIVSS were followed up telephonically or with a home visit one week after receipt of the test kit to confirm results and linkages to care. Follow-up visits were concluded when the participant indicated that they had used the kit or had accessed a confirmatory HIV test. RESULTS: Of the 2061 people approached, 88.2% (1818/2061) received HIV testing information. Of this group, 89% (1618/1818) were enrolled in the study and 70.0% (1133/1618) were tested for HIV with the kit. The median age was 28 (IQR:23-33) years with an even gender distribution. Of those enrolled, 43.0% (696/1618) were identified through homebased outreach, 42.5% (687/1618) through mobile sites, 7.3% (118/1618) at their workplace and 7.2% (117/1618) from sex worker programmes. A total of 68.7% (1110/1616) selected unsupervised HIVSS, whereas 6.3% (101/1616) opted for semi-supervised and 25.0% ((405/1616) chose supervised HIVSS. Overall, the HIV prevalence using the HIVSS test was 8.2% (93/1129). Of those newly diagnosed with HIV, 16% (12/75) were initiated on ART. Almost half (48.0%; 543/1131) of those tested were linked to a primary HIV test as follows: supervised (85.2%; 336/394); semi-supervised (93.8%; 91/97) and unsupervised (18.1%; 116/640). CONCLUSION: Unsupervised HIVSS was by far the most selected and utilised HIVSS method. Linkages to primary and confirmatory testing for the unsupervised HIVSS and further care were low, despite home visits and telephonic reminders.
背景：艾滋病病毒诊断是将感染艾滋病病毒的个体与护理和治疗联系起来，并将未感染艾滋病病毒的人与预防服务联系起来的关键步骤。然而，在许多国家，艾滋病病毒检测的接受率仍然很低。艾滋病病毒自我筛查（HIVSS）成人可以接受，但关于社区方案中 HIVSS 可行性的数据有限。本研究旨在评估南非进行 HIVSS 的可行性。
方法：我们进行了一项前瞻性研究，2017 年 5 月至 11 月期间通过流动站点、家庭、工作场所和性工作者方案招募参与者。在进行 HIVSS 信息介绍后，有兴趣的参与者可以选择以下三种 HIVSS 检测方法之一：监督、半监督和非监督。选择非监督检测的参与者和在半监督或监督 HIVSS 后检测出 HIV 阳性的参与者将在一周后通过电话或家访进行随访，以确认检测结果并将其与护理联系起来。当参与者表示已使用试剂盒或已接受确认性 HIV 检测时，随访结束。
结果：在接触的 2061 人中，88.2%（1818/2061）接受了 HIV 检测信息。在这一组中，89%（1618/1818）入组了研究，70.0%（1133/1618）用试剂盒进行了 HIV 检测。中位年龄为 28 岁（IQR：23-33），性别分布均匀。在入组者中，43.0%（696/1618）是通过家庭外展发现的，42.5%（687/1618）是通过流动站点，7.3%（118/1618）是在工作场所，7.2%（117/1618）是从性工作者方案中发现的。共有 68.7%（1110/1616）选择了非监督 HIVSS，而 6.3%（101/1616）选择了半监督，25.0%（405/1616）选择了监督 HIVSS。总体而言，使用 HIVSS 检测的 HIV 流行率为 8.2%（93/1129）。在新诊断出的 HIV 感染者中，16%（12/75）开始接受抗逆转录病毒治疗。接受检测的人中，近一半（48.0%；543/1131）被联系到初级 HIV 检测，方式如下：监督（85.2%；336/394）；半监督（93.8%；91/97）和非监督（18.1%；116/640）。
结论：迄今为止，非监督 HIVSS 是最受欢迎和最常用的 HIVSS 方法。尽管进行了家访和电话提醒，但非监督 HIVSS 以及进一步的护理与初级和确认性检测的联系率仍然很低。
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