Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Revolving Fund for Vaccine Procurement, Pan American Health Organization, Washington, DC, United States of America.
PLoS One. 2021 May 10;16(5):e0249877. doi: 10.1371/journal.pone.0249877. eCollection 2021.
The Curitiba (Brazil)-based Project, A Hora é Agora (AHA), evaluated a comprehensive HIV control strategy among men who have sex with men (MSM) aimed at expanding access to HIV rapid testing and linking HIV-positive MSM to health services and treatment. AHA's approach included rapid HIV Testing Services (HTC) in one mobile testing unit (MTU); a local, gay-led, non-governmental organization (NGO); an existing government-run health facility (COA); and Internet-based HIV self-testing. The objectives of the paper were to compare a) number of MSM tested in each strategy, its positivity and linkage; b) social, demographic and behavioral characteristics of MSM accessing the different HTC and linkage services; and c) the costs of the individual strategies to diagnose and link MSM to services.
We used data for 2,681 MSM tested at COA, MTU and NGO from March 2015 to March 2017. This is a cross sectional comparison of the demographics and behavioral factors (age group, race/ethnicity, education, sexually transmitted diseases, knowledge of AHA services and previous HIV test). Absolute frequencies, percentage distributions and confidence intervals for the percentages were used, as well as unilateral statistical tests.
AHA performed 2,681 HIV tests among MSM across three in-person strategies: MTU, NGO, and COA; and distributed 4,752 HIV oral fluid tests through the self-testing platform. MTU, NGO and COA reported 365 (13.6%) HIV positive diagnoses among MSM, including 28 users with previous HIV diagnosis or on antiretroviral treatment for HIV. Of these, 89% of MSM were eligible for linkage-to-care services. Linkage support was accepted by 86% of positive MSM, of which 66.7% were linked to services in less than 90 days. The MTU resulted in the lowest cost per MSM tested ($137 per test), followed by self-testing ($247).
AHA offered MSM access to HTC through innovative strategies operating in alternative sites and schedules. It presented the Curitiba HIV/AIDS community the opportunity to monitor HIV-positive MSM from diagnosis to treatment uptake. Self-testing emerged as a feasible strategy to increase MSM access to HIV-testing through virtual tools and anonymous test kit delivery and pick-up. Cost per test findings in both the MTU and self-testing support expansion to other regions with similar epidemiological contexts.
巴西库里蒂巴的 A Hora é Agora（AHA）项目评估了一项针对男男性行为者（MSM）的综合艾滋病毒控制策略，旨在扩大艾滋病毒快速检测的可及性，并将艾滋病毒阳性 MSM 与卫生服务和治疗联系起来。AHA 的方法包括在一个移动检测单元（MTU）中提供快速艾滋病毒检测服务（HTC）；一个当地的、由同性恋者领导的非政府组织（NGO）；一个现有的政府运营的卫生机构（COA）；以及基于互联网的艾滋病毒自我检测。本文的目的是比较：a）每种策略检测的 MSM 数量、阳性率和联系率；b）通过不同 HTC 和联系服务获得检测的 MSM 的社会、人口统计学和行为特征；c）诊断和将 MSM 联系到服务的各个策略的成本。
我们使用了 2015 年 3 月至 2017 年 3 月期间在 COA、MTU 和 NGO 接受检测的 2681 名 MSM 的数据。这是对不同 HTC 和联系服务的 MSM 的人口统计学和行为因素（年龄组、种族/族裔、教育、性传播疾病、对 AHA 服务的了解和以前的 HIV 检测）的横断面比较。使用了绝对频率、百分比分布和百分比的置信区间，以及单边统计检验。
AHA 通过三种面对面的策略（MTU、NGO 和 COA）为 MSM 进行了 2681 次艾滋病毒检测；并通过自我检测平台分发了 4752 份艾滋病毒口腔液检测。MTU、NGO 和 COA 报告了 365 名（13.6%）艾滋病毒阳性诊断的 MSM，其中包括 28 名以前诊断为艾滋病毒或正在接受抗逆转录病毒治疗的患者。其中，89%的 MSM 有资格获得联系到护理服务。阳性 MSM 中有 86%接受了联系支持，其中 66.7%在不到 90 天内被联系到服务。MTU 的检测成本最低（每位 MSM 检测费用为 137 美元），其次是自我检测（247 美元）。
AHA 通过在替代地点和时间提供创新的策略，为 MSM 提供了获得 HTC 的机会。它为库里蒂巴艾滋病毒/艾滋病社区提供了监测艾滋病毒阳性 MSM 从诊断到治疗的机会。自我检测作为一种通过虚拟工具和匿名检测试剂盒的交付和收取来增加 MSM 获得艾滋病毒检测的可行策略出现。MTU 和自我检测的每个检测成本发现支持在具有类似流行病学背景的其他地区进行扩展。
