Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
BMC Public Health. 2020 Nov 25;20(1):1777. doi: 10.1186/s12889-020-09832-w.
BACKGROUND: HIV self-testing (HIVST) has the potential to improve HIV testing uptake and frequency for key populations like MSM who experience multiple barriers accessing clinic-based HIV testing. In the absence of HIVST in Malaysia, there is no guidance to inform HIVST delivery. This study investigated the acceptability of HIVST and preferences about the HIVST service delivery approaches using a standardized stated preference method. METHODS: A cross-sectional online survey conducted between January and April 2019 assessed the interest in HIVST in 544 MSM in Malaysia. Participants ranked eight hypothetical HIVST service delivery program elements with varied combinations of six, two-level HIVST service delivery program attributes (cost, privacy, accuracy, kit collection site, kit type, and testing support). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preference across eight possible HIVST service delivery programs. RESULTS: Overall, 70.4% had previously tested for HIV, and of those, 64.0% had done so in the past 6 months (45.0% of all participants). Of all the participants, 25.2% reported having used HIVST previously. The acceptability for HIVST service delivery models ranged from 44.9 to 77.1%, with mean acceptability of 56.2% across the eight hypothetical HIVST distribution scenarios. The HIVST service delivery scenario with the highest acceptability had the following attributes: no cost (free), anonymity (name not required), 99-100% accuracy, home-delivered, fingerstick, and testing support using telephone hotline or texting. HIVST cost was the most important attribute (relative importance score: RIS = 19.30) associated with acceptability, followed by anonymity (RIS = 18.41), accuracy (RIS = 17.33), kit delivery (RIS = 16.99), fingerstick kit (RIS = 15.86), and support (RIS = 12.08). CONCLUSIONS: Acceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs.
背景：艾滋病毒自检（HIVST）有可能提高关键人群（如男男性行为者）的艾滋病毒检测率和检测频率，因为这些人群在接受基于诊所的艾滋病毒检测方面面临多种障碍。在马来西亚，HIVST 尚未普及，因此缺乏有关 HIVST 交付的指导。本研究使用标准化的陈述偏好法，调查了 HIVST 的可接受性以及对 HIVST 服务提供方法的偏好。
方法：2019 年 1 月至 4 月期间，通过横断面在线调查评估了 544 名马来西亚男男性行为者对 HIVST 的兴趣。参与者对八种假设的 HIVST 服务提供方案元素进行了排名，这些方案元素具有成本、隐私、准确性、试剂盒收集地点、试剂盒类型和检测支持等六个两级 HIVST 服务提供方案属性的不同组合。SPSS 联合程序用于估计每个属性和偏好在八种可能的 HIVST 服务提供方案中的相对重要性。
结果：总体而言，70.4%的参与者之前曾接受过艾滋病毒检测，其中 64.0%的人在过去 6 个月内进行了检测（所有参与者中有 45.0%）。在所有参与者中，25.2%的人之前曾使用过 HIVST。HIVST 服务交付模型的可接受性范围为 44.9%至 77.1%，在八种假设的 HIVST 分布情景中，平均可接受性为 56.2%。接受程度最高的 HIVST 服务交付方案具有以下属性：无成本（免费）、匿名（无需提供姓名）、99-100%的准确性、家庭交付、指尖采血和使用电话热线或短信提供检测支持。HIVST 成本是与可接受性最相关的最重要属性（相对重要性评分：RIS=19.30），其次是匿名性（RIS=18.41）、准确性（RIS=17.33）、试剂盒交付（RIS=16.99）、指尖采血试剂盒（RIS=15.86）和支持（RIS=12.08）。
结论：马来西亚男男性行为者对 HIVST 的可接受性较高，但对许多 HIVST 交付方案和属性的接受程度差异显著。马来西亚卫生部正在制定一套监管框架，以确保试剂盒的质量，并制定支持安全使用的政策，在此背景下，这些发现可能具有相关性，同时在国家艾滋病规划下更广泛地实施。
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