Department of Global Health, University of Washington, Seattle, USA.
Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, USA.
J Int AIDS Soc. 2020 Jun;23 Suppl 2(Suppl 2):e25514. doi: 10.1002/jia2.25514.
In South Africa, HIV-infected men are less likely than women to test and know their status (the first UNAIDS "90-90-90" target), and men have worse outcomes across the HIV care cascade. HIV self-testing (HIVST) may address this testing disparity but questions remain over the most effective distribution strategy and linkage following a positive test result. We implemented a men-focused HIVST distribution programme to evaluate components contributing to participation and retention.
We conducted an implementation study of multi-venue HIVST kit distribution in rural and peri-urban KwaZulu-Natal (KZN), South Africa. We distributed HIVST kits at community points, workplaces and social venues for on site or take-home use. Clients could choose blood-based or oral-fluid-based HIVST kits and elect to watch an in-person or video demonstration. We provided a USD2 incentive to facilitate reporting test results by phone or SMS. Persons with reactive HIVST results were provided immediate confirmatory tests (if used HIVST on site) or were referred for confirmatory testing (if took HIVST off site) and linkage to care for ART initiation. We describe the testing and linkage cascade in this sample and describe predictors of reactive HIVST results and linkage.
Between July and November 2018, we distributed 4496 HIVST kits in two regions of KZN (96% to men, median age 28 (IQR 23 to 35). Most participants (58%) chose blood-based HIVST and 42% chose oral-swab kits. 11% of men were testing for the first time. A total of 3902 (83%) of testers reported their test result to the study team, with 314 (8%) screening positive for HIV. Among 274 men with reactive HIVST results, 68% linked to ART; no significant predictors of linkage were identified. 10% of kit users reported they would prefer a different type (oral vs. blood) of kit for repeat testing than the type they used.
HIVST is acceptable to men and rapid distribution with optional testing support is feasible in rural and peri-urban settings. HIVST kits successfully reached younger men and identified undetected infections. Both oral and blood-based HIVST were selected. Scaling up HIVST distribution and guidance may increase the number of first-time testers among men and help achieve the first UNAIDS "90" for men in South Africa.
在南非，感染 HIV 的男性比女性更不可能进行检测并了解自己的状况（UNAIDS 的第一个“90-90-90”目标），并且在整个 HIV 护理链中，男性的结果更差。HIV 自检（HIVST）可能会解决这一检测差距问题，但对于最有效的分发策略以及阳性检测结果后的联系仍存在疑问。我们实施了一项以男性为重点的 HIVST 分发计划，以评估参与和保留的各个组成部分。
我们在南非夸祖鲁-纳塔尔省（KZN）的农村和城市周边地区开展了一项多场所 HIVST 试剂盒分发的实施研究。我们在社区点、工作场所和社交场所分发 HIVST 试剂盒，供现场或带回家使用。客户可以选择基于血液或口腔液的 HIVST 试剂盒，并选择观看现场或视频演示。我们提供 2 美元的激励措施，以方便通过电话或短信报告检测结果。对 HIVST 结果呈阳性的人立即提供确认检测（如果现场使用 HIVST）或被转介进行确认检测（如果场外使用 HIVST），并开始接受抗逆转录病毒治疗。我们在此样本中描述了检测和联系的级联，并描述了 HIVST 结果呈阳性和联系的预测因素。
2018 年 7 月至 11 月期间，我们在 KZN 的两个地区分发了 4496 份 HIVST 试剂盒（96%分发给男性，中位年龄 28 岁（IQR 23 至 35）。大多数参与者（58%）选择了基于血液的 HIVST，42%选择了口腔拭子试剂盒。11%的男性是首次检测。共有 3902 名（83%）检测者向研究小组报告了检测结果，其中 314 名（8%）检测出 HIV 阳性。在 274 名 HIVST 结果呈阳性的男性中，有 68%的人联系到了抗逆转录病毒治疗；没有发现与联系相关的显著预测因素。10%的试剂盒使用者表示，他们希望在进行重复检测时选择与首次检测不同的试剂盒类型（口腔 vs. 血液）。
HIVST 可被男性接受，并且在农村和城市周边地区可以快速分发并提供可选的检测支持。HIVST 试剂盒成功地覆盖了更年轻的男性，并发现了未被发现的感染。同时选择了基于口腔和血液的 HIVST。扩大 HIVST 的分发和指导可能会增加男性中的首次检测人数，并有助于实现南非第一个 UNAIDS“90”目标。
