Yunus Jessie Olivia, Sawitri Anak Agung Sagung, Wirawan Dewa Nyoman, Mahendra I Gusti Agung Agus, Susanti Dewi, Utami Ds Ni Kadek Ayu Dwi, Asanab Dedison, Narayani Ida Ayu, Mukuan Oldri Sherli, Widihastuti Asti, Magnani Robert, Januraga Pande Putu
Kerti Praja Foundation, Denpasar Bali, Indonesia.
Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar Bali, Indonesia.
JMIR Res Protoc. 2021 Jul 21;10(7):e27168. doi: 10.2196/27168.
BACKGROUND: New HIV infections in Indonesia continue to be concentrated among key populations, including female sex workers (FSWs). However, increasing HIV testing among this subpopulation remains a challenge, necessitating exploration into alternative testing modalities. OBJECTIVE: This study aims to assess whether the addition of an oral fluid testing option in community settings would increase the rate of HIV case identification among FSWs. Because the study was implemented early in the outbreak of COVID-19 in Indonesia, a secondary objective is to assess approaches and tools for implementing both community outreach and community HIV screening for FSWs during pandemic conditions. METHODS: We undertook a community-based randomized trial in 23 national priority districts in which community outreach services were being provided. Community-based screening using an oral fluid-based rapid test was added to the community outreach standard of care in intervention districts with clients having the option of performing the test themselves or being assisted by outreach workers. A web-based system was created to screen for eligibility and collect participant data and test results, facilitating the process for both unassisted and assisted participants. Participants with reactive screening results were encouraged to undergo HIV testing at a health facility to confirm their diagnosis and initiate antiretroviral treatment as needed. Multiple means of recruitment were deployed including through outreach workers and social media campaigns. RESULTS: Of the 1907 FSWs who registered, met the eligibility criteria, and gave consent to participate, 1545 undertook community oral fluid test (OFT) screening. Most (1516/1545, 98.1%) opted for assisted screening. Recruitment via social media fell far short of expectations as many who registered independently for the OFT because of the social media campaign did not identify as FSWs. They were eventually not eligible to participate, but their interest points to the possibility of implementing HIV self-testing in the general population. The successful recruitment through outreach workers, facilitated by social media, indicates that their roles remain crucial in accessing FSW networks and improving HIV testing uptake. CONCLUSIONS: The addition of HIV self-testing to the standard of care supported by a web-based data collection system was able to increase HIV case identification among FSWs in intervention districts. The high satisfaction of OFT users and the interest of the general population toward this alternative testing modality are promising for scaling up community HIV screening nationally. TRIAL REGISTRATION: ClinicalTrials.gov NCT04578145; https://clinicaltrials.gov/ct2/show/NCT04578145. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/27168.
背景:印度尼西亚的新增艾滋病毒感染病例继续集中在包括女性性工作者(FSW)在内的重点人群中。然而,增加这一亚人群的艾滋病毒检测仍然是一项挑战,需要探索替代检测方式。 目的:本研究旨在评估在社区环境中增加口腔液检测选项是否会提高女性性工作者中的艾滋病毒病例识别率。由于该研究在印度尼西亚新冠疫情爆发初期实施,第二个目标是评估在大流行条件下对女性性工作者实施社区外展和社区艾滋病毒筛查的方法和工具。 方法:我们在23个提供社区外展服务的国家重点地区进行了一项基于社区的随机试验。在干预地区,将使用口腔液快速检测的社区筛查添加到社区外展标准护理中,客户可以选择自己进行检测或由外展工作者协助。创建了一个基于网络的系统来筛查资格并收集参与者数据和检测结果,为自助和受助参与者简化流程。鼓励筛查结果呈反应性的参与者在医疗机构进行艾滋病毒检测,以确认诊断并根据需要启动抗逆转录病毒治疗。采用了多种招募方式,包括通过外展工作者和社交媒体活动。 结果:在1907名登记、符合资格标准并同意参与的女性性工作者中,1545人接受了社区口腔液检测(OFT)筛查。大多数(1516/1545,98.1%)选择了受助筛查。通过社交媒体招募远未达到预期,因为许多因社交媒体活动而独立登记参加OFT的人并非女性性工作者。他们最终没有资格参与,但他们的兴趣表明在普通人群中实施艾滋病毒自我检测的可能性。在社交媒体的推动下,通过外展工作者成功招募,表明他们在进入女性性工作者网络和提高艾滋病毒检测接受率方面的作用仍然至关重要。 结论:在基于网络的数据收集系统支持的标准护理中增加艾滋病毒自我检测,能够提高干预地区女性性工作者中的艾滋病毒病例识别率。口腔液检测用户的高满意度以及普通人群对这种替代检测方式的兴趣,为在全国范围内扩大社区艾滋病毒筛查带来了希望。 试验注册:ClinicalTrials.gov NCT04578145;https://clinicaltrials.gov/ct2/show/NCT04578145。 国际注册报告识别号(IRRID):RR1-10.2196/27168。
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