Nanjing Medical University, Nanjing, Jiangsu, China.
Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
PLoS One. 2020 Apr 22;15(4):e0232094. doi: 10.1371/journal.pone.0232094. eCollection 2020.
BACKGROUND: The World Health Organization has recommended HIV self-testing (HIVST) as an alternative testing strategy given the limitations of facility-based testing. While the benefits of HIV self-testing have been demonstrated at the individual level among men who have sex with men (MSM), limited data exist on if this testing approach can be effectively diffused through individuals' social or sexual networks. The objectives of this study were to examine patterns and correlates of HIVST distribution within Chinese MSM's sexual networks. METHODS: Data used for this analysis was a part of the process evaluation of an HIVST intervention trial among MSM in Nanjing, China. Between May and October 2017, we enrolled 400 men into the trial. Participants assigned to the intervention group (N = 200) were given three HIVST kits at baseline and could request more during the follow-up periods. We incorporated measures for process evaluation in the self-administered online follow-up surveys. This analysis reported findings from the three-month follow-up survey in the intervention group. Frequencies and percentages were used to describe characteristics of participants who distributed kits to their sexual partners as well as patterns of distribution. Multivariable logistic regression was conducted to identify independent correlates of participants who distributed the kits. RESULTS: Of the 177 participants retained (88.5%) at the three-month follow-up, 72 (40.7%) distributed one or more kits to either primary or casual partners. About half of distributors (51.4%) gave one HIVST kit to their sexual partners while 15.3% distributed 3 or more. Over half gave these kits (58.3%) to primary sexual partners while 27.8% reported giving the kits to both primary and casual partners. About half (54.2%) of distributors used the kits together with their partners. Compared to participants who had an HIV test in the past six months, those who tested over six months ago or never tested had significantly lower odds of distributing the kits (AOR = 0.484, 95% CI: 0.250-0.983, p = 0.032). Compared to those who had not used the kits themselves, participants who did had significantly higher odds of distributing the kits (AOR = 3.345, 95% CI: 1.488-7.517, p = 0.003). Participants who reported higher HIV testing efficacy had 2.051 fold greater odds (95% CI: 1.062-3.961, p = 0.033) of distributing the kits compared to those who had lower efficacy. CONCLUSION: Our study demonstrated that a sexual network-based approach to distributing HIVST among Chinese MSM is feasible and can be a promising strategy to improve the effectiveness of HIVST programs including its reach to untested men. Such approach should be complimented by intervention components that enhance HIV testing efficacy and improve experiences of HIVST.
背景:鉴于机构检测的局限性,世界卫生组织已推荐 HIV 自我检测(HIVST)作为替代检测策略。尽管 HIV 自我检测在男男性行为者(MSM)个体层面上的益处已得到证实,但关于这种检测方法是否可以通过个体的社交或性网络有效传播的证据有限。本研究的目的是调查中国 MSM 性网络中 HIVST 分布的模式和相关性。
方法:本分析使用的数据是中国南京一项 MSM 中 HIVST 干预试验的过程评估的一部分。2017 年 5 月至 10 月期间,我们招募了 400 名男性参加试验。被分配到干预组的参与者(N=200)在基线时获得了三个 HIVST 试剂盒,并且在随访期间可以要求更多。我们在自我管理的在线随访调查中纳入了用于过程评估的措施。本分析报告了干预组三个月随访调查的结果。频率和百分比用于描述向性伴侣分发试剂盒的参与者的特征以及分发模式。采用多变量逻辑回归确定参与者分发试剂盒的独立相关性。
结果:在三个月的随访中,177 名(88.5%)保留的 177 名参与者中,72 名(40.7%)向主要或偶然伴侣分发了一个或多个试剂盒。约一半的分发者(51.4%)将一个 HIVST 试剂盒给了他们的性伴侣,而 15.3%的分发者分发了 3 个或更多。超过一半的分发者(58.3%)将这些试剂盒分发给主要性伴侣,而 27.8%的分发者报告将试剂盒分发给主要和偶然伴侣。大约一半(54.2%)的分发者与他们的伴侣一起使用了这些试剂盒。与过去六个月内接受过 HIV 检测的参与者相比,过去六个月以上或从未接受过检测的参与者分发试剂盒的可能性显著降低(AOR=0.484,95%CI:0.250-0.983,p=0.032)。与未自行使用试剂盒的参与者相比,使用过试剂盒的参与者分发试剂盒的可能性显著更高(AOR=3.345,95%CI:1.488-7.517,p=0.003)。报告 HIV 检测效果更高的参与者分发试剂盒的可能性是报告效果较低的参与者的 2.051 倍(95%CI:1.062-3.961,p=0.033)。
结论:我们的研究表明,在中国 MSM 中,基于性网络分发 HIVST 是可行的,并且可能是一种有前途的策略,可以提高 HIVST 计划的有效性,包括扩大到未接受检测的男性。这种方法应该辅以增强 HIV 检测效果和改善 HIVST 体验的干预措施。
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