Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya.
Yale University School of Nursing, Orange, Connecticut.
J Adolesc Health. 2021 Mar;68(3):497-507. doi: 10.1016/j.jadohealth.2020.07.007. Epub 2020 Aug 11.
To improve testing coverage, it is imperative to determine adolescent girls and young women (AGYW) preferences about HIV testing modality and where they prefer receiving services.
Participants were enrolled between May 2017 and April 2018 from three sites in Homa Bay County, Nyanza region, western Kenya. We explored two recruitment approaches (home-based vs. mobile-event based) and three HIV testing options (oral self-test, staff-administered, or referral to health facility). Exact logistic regression compared yield of newly diagnosed HIV and high-risk HIV-negatives from the recruitment and testing option strategies.
A total of 1,198 participants were enrolled, 1,046 (87.3%) at home and 152 (12.7%) at mobile events. Most participants (928, 77.5%) chose staff-aided testing either at home or at a mobile event; 268 (22.4%) chose self-testing; and only 2 (.2%) chose facility referral. Prevalence of newly diagnosed HIV-positives was 2.7% (32/1,198) and 36.8% (429/1,166) of HIV-negative AGYW were identified as high risk. We identified more newly diagnosed HIV infection among AGYW recruited at mobile events than at home (OR = 3.11; 95% CI: 1.33-6.74; p = .02). High-risk status was related to neither recruitment strategy nor testing modality. Older age was associated with increased odds of selecting an oral self-test (OR = 1.85; 95% CI: 1.06-3.22).
More than one-third of AGYW were at elevated risk of HIV infection, and those unaware of their HIV infection were more likely to be identified at a mobile outreach. Though self-testing was not the dominant preferred strategy, self-tests were performed accurately and with high confidence. These findings can help inform efficient identification of undiagnosed HIV infection and high risk for seroconversion among AGYW in similar settings.
为了提高检测覆盖率，确定青少年女孩和年轻妇女（AGYW）对 HIV 检测方式的偏好以及他们希望在哪里获得服务至关重要。
参与者于 2017 年 5 月至 2018 年 4 月在肯尼亚西部尼安萨地区霍马贝县的三个地点入组。我们探索了两种招募方法（家庭基础与移动事件基础）和三种 HIV 检测选项（口腔自我检测、工作人员辅助检测或转介至医疗机构）。精确逻辑回归比较了从招募和检测选择策略中获得的新诊断 HIV 和高风险 HIV 阴性的结果。
共有 1198 名参与者入组，其中 1046 名（87.3%）在家中，152 名（12.7%）在移动事件中。大多数参与者（928 名，77.5%）选择在家中或移动事件中由工作人员辅助检测；268 名（22.4%）选择自我检测；只有 2 名（0.2%）选择医疗机构转介。新诊断的 HIV 阳性率为 2.7%（32/1198），1166 名 HIV 阴性的 AGYW 中有 36.8%（429 名）被确定为高危。我们发现，在移动事件中招募的 AGYW 中新诊断的 HIV 感染比例高于在家中招募的（OR=3.11；95%CI：1.33-6.74；p=0.02）。高危状态与招募策略或检测方式均无关。年龄较大与选择口腔自我检测的可能性增加相关（OR=1.85；95%CI：1.06-3.22）。
超过三分之一的 AGYW 存在 HIV 感染的高风险，那些不知道自己 HIV 感染状况的人更有可能在移动外展中被发现。虽然自我检测不是首选策略，但自我检测准确且信心较高。这些发现可以帮助在类似环境中为 AGYW 提供高效的未确诊 HIV 感染和血清转换高风险识别。
