在 HIV 阳性的男男性行为者中开展淋病、衣原体、乙型肝炎和梅毒自我采样的家庭护理计划的试点实施。
Pilot implementation of a home-care programme with chlamydia, gonorrhoea, hepatitis B, and syphilis self-sampling in HIV-positive men who have sex with men.
机构信息
Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD Zuid Limburg), Heerlen, the Netherlands.
Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
出版信息
BMC Infect Dis. 2020 Dec 4;20(1):925. doi: 10.1186/s12879-020-05658-4.
BACKGROUND
Not all men who have sex with men (MSM) at risk for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infection currently receive sexual healthcare. To increase the coverage of high-quality HIV/STI care for MSM, we developed a home-care programme, as extended STI clinic care. This programme included home sampling for testing, combined with treatment and sexual health counselling. Here, we pilot implemented the programme in a hospital setting (HIV-positive MSM) to determine the factors for the successful implementation of STI home sampling strategies.
METHODS
Healthcare providers from the HIV hospital treatment centre (Maastricht) were invited to offer free STI sampling kits (syphilis, hepatitis B, [extra]genital chlamydia and gonorrhoea laboratory testing) to their HIV-positive MSM patients (March to May 2018). To evaluate implementation of the program, quantitative and qualitative data were collected to assess adoption (HIV care providers offered sampling kits to MSM), participation (MSM accepted the sampling kits) and sampling-kit return, STI diagnoses, and implementation experiences.
RESULTS
Adoption was 85.3% (110/129), participation was 58.2% (64/110), and sampling-kit return was 43.8% (28/64). Of the tested MSM, 64.3% (18/28) did not recently (< 3 months) undergo a STI test; during the programme, 17.9% (5/28) were diagnosed with an STI. Of tested MSM, 64.3% (18/28) was vaccinated against hepatitis B. MSM reported that the sampling kits were easily and conveniently used. Care providers (hospital and STI clinic) considered the programme acceptable and feasible, with some logistical challenges. All (100%) self-taken chlamydia and gonorrhoea samples were adequate for testing, and 82.1% (23/28) of MSM provided sufficient self-taken blood samples for syphilis screening. However, full syphilis diagnostic work-up required for MSM with a history of syphilis (18/28) was not possible in 44.4% (8/18) of MSM because of insufficient blood sampled.
CONCLUSION
The home sampling programme increased STI test uptake and was acceptable and feasible for MSM and their care providers. Return of sampling kits should be further improved. The home-care programme is a promising extension of regular STI care to deliver comprehensive STI care to the home setting for MSM. Yet, in an HIV-positive population, syphilis diagnosis may be challenging when using self-taken blood samples.
背景
并非所有有性行为的男男性接触者（MSM）都有感染性传播感染（STI）和人类免疫缺陷病毒（HIV）的风险。为了提高针对 MSM 的高质量 HIV/STI 护理的覆盖率，我们开发了一种家庭护理计划，作为扩展的 STI 诊所护理。该计划包括家庭取样进行检测，并结合治疗和性健康咨询。在这里，我们在医院环境中试点实施了该计划（HIV 阳性 MSM），以确定成功实施 STI 家庭取样策略的因素。
方法
邀请来自马斯特里赫特 HIV 医院治疗中心的医疗保健提供者向他们的 HIV 阳性 MSM 患者提供免费的 STI 取样套件（梅毒、乙型肝炎、[额外]生殖器衣原体和淋病实验室检测）（2018 年 3 月至 5 月）。为了评估该计划的实施情况，收集了定量和定性数据，以评估采用情况（HIV 护理提供者向 MSM 提供取样套件）、参与情况（MSM 接受取样套件）和取样套件的返回情况、STI 诊断以及实施经验。
结果
采用率为 85.3%（110/129），参与率为 58.2%（64/110），取样套件返回率为 43.8%（28/64）。在接受测试的 MSM 中，64.3%（18/28）最近（<3 个月）未进行 STI 检测；在该计划期间，17.9%（5/28）被诊断出患有 STI。在接受测试的 MSM 中，64.3%（18/28）接种了乙型肝炎疫苗。MSM 报告说，取样套件使用方便。医疗保健提供者（医院和 STI 诊所）认为该计划是可以接受且可行的，但存在一些后勤挑战。所有（100%）自行采集的衣原体和淋病样本均适合检测，82.1%（28/28）的 MSM 提供了足够的自行采集的血液样本进行梅毒筛查。然而，由于取样不足，18/28 名有梅毒病史的 MSM 无法进行梅毒全诊断工作。
结论
家庭取样计划增加了 STI 检测的采用率，并且对 MSM 和他们的护理提供者来说是可以接受且可行的。取样套件的返回情况应进一步改善。家庭护理计划是对常规 STI 护理的一个有前途的扩展，可将全面的 STI 护理送到 MSM 的家庭环境中。然而，在 HIV 阳性人群中，使用自行采集的血液样本进行梅毒诊断可能具有挑战性。
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