Global HIV, Hepatitis and STI programme, World Health Organization, Geneva, Switzerland.
Department of Clinical Research and Infection Disease, London School of Hygiene and Tropical Medicine, London, UK.
BMC Public Health. 2020 May 25;20(1):779. doi: 10.1186/s12889-020-08855-7.
Many southern African countries are nearing the global goal of diagnosing 90% of people with HIV by 2020. In 2016, 84 and 86% of people with HIV knew their status in Malawi and Zimbabwe, respectively. However, gaps remain, particularly among men. We investigated awareness and use of, and willingness to self-test for HIV and explored sociodemographic associations before large-scale implementation.
We pooled responses from two of the first cross-sectional Demographic and Health Surveys to include HIV self-testing (HIVST) questions in Malawi and Zimbabwe in 2015-16. We investigated sociodemographic factors and sexual risk behaviours associated with previously testing for HIV, and past use, awareness of, and future willingness to self-test using univariable and multivariable logistic regression, adjusting for the sample design and limiting analysis to participants with a completed questionnaire and valid HIV test result. We restricted analysis of willingness to self-test to Zimbabwean men, as women and Malawians were not systematically asked this question.
Of 31,385 individuals, 31.2% of men had never tested compared with 16.5% of women (p < 0.001). For men, the likelihood of having ever tested increased with age. Past use and awareness of HIVST was very low, 1.2 and 12.6%, respectively. Awareness was lower among women than men (9.1% vs 15.3%, adjusted odds ratio [aOR] = 1.55; 95% confidence interval [CI]: 1.37-1.75), and at younger ages, and lower education and literacy levels. Willingness to self-test among Zimbabwean men was high (84.5%), with greater willingness associated with having previously tested for HIV, being at high sexual risk (highest willingness [aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009]), and being ≥25 years old. Wealthier men had greater awareness of HIVST than poorer men (p < 0.001). The highest willingness to self-test (aOR = 3.74; 95%CI: 1.39-10.03, p < 0.009) was among men at high HIV-related sexual risk.
In 2015-16, many Malawian and Zimbabwean men had never tested for HIV. Despite low awareness and minimal HIVST experience, willingness to self-test was high among Zimbabwean men, especially older men with moderate-to-high HIV-related sexual risk. These data provide a valuable baseline against which to investigate population-level uptake of HIVST as programmes scale up. Programmes introducing, or planning to introduce, HIVST should consider including relevant questions in population-based surveys.
许多南部非洲国家已接近 2020 年全球 90%的艾滋病毒感染者得到诊断的目标。2016 年，马拉维和津巴布韦分别有 84%和 86%的艾滋病毒感染者知晓其艾滋病毒感染状况。然而，仍存在差距，尤其是在男性中。我们研究了艾滋病毒意识、艾滋病毒自我检测的使用情况和意愿，并在大规模实施前探讨了与社会人口学相关的因素。
我们汇总了 2015-16 年马拉维和津巴布韦首次进行的两项人口与健康调查中的数据，这两项调查都包含艾滋病毒自我检测（HIVST）问题。我们使用单变量和多变量逻辑回归调查了与之前接受艾滋病毒检测、过去使用、知晓和未来自我检测意愿相关的社会人口学因素和性风险行为，并对样本设计进行了调整，且仅对完成问卷和有效艾滋病毒检测结果的参与者进行了分析。我们将自我检测意愿的分析仅限于津巴布韦男性，因为没有系统地询问女性和马拉维人这个问题。
在 31385 人中，31.2%的男性从未接受过检测，而女性为 16.5%（p<0.001）。对于男性来说，接受过检测的可能性随着年龄的增长而增加。过去使用和知晓 HIVST 的比例非常低，分别为 1.2%和 12.6%。女性的知晓率低于男性（9.1%对 15.3%，调整后的优势比[aOR]为 1.55；95%置信区间[CI]：1.37-1.75），且在较年轻、教育和读写水平较低时知晓率更低。津巴布韦男性自我检测意愿很高（84.5%），与之前接受过艾滋病毒检测、性风险较高（最高意愿[aOR]为 3.74；95%CI：1.39-10.03，p<0.009）和年龄≥25 岁有关。较富裕的男性比较贫穷的男性对 HIVST 的认知度更高（p<0.001）。高 HIV 相关性风险的男性自我检测意愿最高（aOR 为 3.74；95%CI：1.39-10.03，p<0.009）。
2015-16 年，马拉维和津巴布韦的许多男性从未接受过艾滋病毒检测。尽管对 HIVST 的认知度较低，且很少有自我检测的经验，但津巴布韦男性的自我检测意愿较高，尤其是处于中度至高度 HIV 相关性风险的年长男性。这些数据为评估随着项目规模扩大而进行的人群水平自我检测情况提供了宝贵的基线。正在引入或计划引入 HIVST 的项目应考虑在基于人群的调查中纳入相关问题。
