获得HIV自我检测对高危男同性恋和双性恋男性HIV检测频率的长期影响：一项随机对照试验的随访数据
The longer-term effects of access to HIV self-tests on HIV testing frequency in high-risk gay and bisexual men: follow-up data from a randomised controlled trial.
作者信息
Zhang Ye, Jamil Muhammad S, Smith Kirsty S, Applegate Tanya L, Prestage Garrett, Holt Martin, Keen Phillip, Bavinton Benjamin R, Chen Marcus, Conway Damian P, Wand Handan, McNulty Anna M, Russell Darren, Vaughan Matthew, Batrouney Colin, Wiseman Virginia, Fairley Christopher K, Grulich Andrew E, Law Matthew, Kaldor John M, Guy Rebecca J
机构信息
Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland.
出版信息
Lancet Reg Health West Pac. 2021 Jul 15;14:100214. doi: 10.1016/j.lanwpc.2021.100214. eCollection 2021 Sep.
BACKGROUND
A wait-list randomised controlled trial in Australia (FORTH) in high-risk gay and bisexual men (GBM) showed access to free HIV self-tests (HIVSTs) doubled the frequency of HIV testing in year 1 to reach guideline recommended levels of 4 tests per year, compared to two tests per year in the standard-care arm (facility-based testing). In year 2, men in both arms had access to HIVSTs. We assessed if the effect was maintained for a further 12 months.
METHODS
Participants included GBM reporting condomless anal intercourse or > 5 male partners in the past 3 months. We included men who had completed at least one survey in both year 1 and 2 and calculated the mean tests per person, based on the validated self-report and clinic records. We used Poisson regression and random effects Poisson regression models to compare the overall testing frequency by study arm, year and testing modality (HIVST/facility-based test).
FINDINGS
Overall, 362 men completed at least one survey in year 1 and 343 in year 2. Among men in the intervention arm (access to HIVSTs in both years), the mean number of HIV tests in year 2 (3⋅7 overall, 2⋅3 facility-based tests, 1⋅4 HIVSTs) was lower compared to year 1 (4⋅1 overall, 1⋅7 facility-based tests, 2⋅4 HIVSTs) (RR:0⋅84, 95% CI:0⋅75-0⋅95, p=0⋅002), but higher than the standard-care arm in year 1 (2⋅0 overall, RR:1⋅71, 95% CI:1⋅48-1.97, p<0⋅001). Findings were not different when stratified by sociodemographic characteristics or recent high risk sexual history.
INTERPRETATION
In year 2, fewer HIVSTs were used on average compared to year 1, but access to free HIVSTs enabled more men to maintain higher HIV testing frequency, compared with facility-based testing only. HIV self-testing should be a key component of HIV testing and prevention strategies.
FUNDING
This work was supported by grant 568971 from the National Health and Medical Research Council of Australia.
背景
澳大利亚一项针对高危男同性恋者和双性恋男性（GBM）的等待名单随机对照试验（FORTH）显示，与标准护理组（基于机构的检测）每年两次检测相比，获得免费的HIV自我检测（HIVST）使第一年的HIV检测频率翻倍，达到指南推荐的每年4次检测水平。在第二年，两组男性都可获得HIVST。我们评估了这种效果是否能再维持12个月。
方法
参与者包括在过去3个月内有肛交无保护性行为或有超过5名男性性伴侣的GBM。我们纳入了在第一年和第二年都至少完成一次调查的男性，并根据经过验证的自我报告和诊所记录计算每人的平均检测次数。我们使用泊松回归和随机效应泊松回归模型，按研究组、年份和检测方式（HIVST/基于机构的检测）比较总体检测频率。
结果
总体而言，362名男性在第一年至少完成了一次调查，343名在第二年完成了调查。在干预组（两年都可获得HIVST）的男性中，第二年的HIV检测平均次数（总体为3.7次，基于机构的检测为2.3次，HIVST为1.4次）低于第一年（总体为4.1次，基于机构的检测为1.7次，HIVST为2.4次）（RR：0.84，95%CI：0.75 - 0.95，p = 0.002），但高于第一年的标准护理组（总体为2.0次，RR：1.71，95%CI：1.48 - 1.97，p < 0.001）。按社会人口学特征或近期高危性行为史分层时，结果无差异。
解读
在第二年，与第一年相比，平均使用的HIVST数量减少，但与仅基于机构的检测相比，可以获得免费HIVST使更多男性维持了更高的HIV检测频率。HIV自我检测应成为HIV检测和预防策略的关键组成部分。
资助
这项工作得到了澳大利亚国家卫生与医学研究委员会568971号拨款的支持。
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