Department of Health Promotion, Education & Behaviour, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
Department of Sociology, University of Johannesburg, Auckland Park, South Africa.
BMJ Open. 2022 Feb 14;12(2):e048780. doi: 10.1136/bmjopen-2021-048780.
OBJECTIVE: Peer-to-peer (PTP) HIV self-testing (HIVST) distribution models can increase uptake of HIV testing and potentially create demand for HIV treatment and pre-exposure prophylaxis (PrEP). We describe the acceptability and experiences of young women and men participating in a cluster randomised trial of PTP HIVST distribution and antiretroviral/PrEP promotion in rural KwaZulu-Natal. METHODS: Between March and September 2019, 24 pairs of trained peer navigators were randomised to two approaches to distribute HIVST packs (kits+HIV prevention information): where peer-age friends distributed packs within their social network for a small incentive, or where peer navigators distributed HIVST packs directly. S peer navigators distributed information without HIVST kits. For the process evaluation, we conducted semi-structured interviews with purposively sampled young women (n=30) and men (n=15) aged 18-29 years from all arms. Qualitative data were transcribed, translated, coded manually and thematically analysed using an interpretivist approach. RESULTS: Overall, PTP approaches were acceptable and valued by young people. Participants were comfortable sharing sexual health issues they would not share with adults. Coupled with HIVST, peer (friends) support facilitated HIV testing and solidarity for HIV status disclosure and treatment. However, some young people showed limited interest in other sexual health information provided. Some young people were wary of receiving health information from friends perceived as non-professionals while others avoided sharing personal issues with peer navigators from their community. Referral slips and youth-friendly clinics were facilitators to PrEP uptake. Family disapproval, limited information, daily pills and perceived risks were major barriers to PrEP uptake. CONCLUSION: Both professional (peer navigators) and social network (friends) approaches were acceptable methods to receive HIVST and sexual health information. Doubts about the professionalism of friends and overly exclusive focus on HIVST information materials may in part explain why HIVST kits, without peer navigators support, did not create demand for PrEP.
目的：点对点（PTP）艾滋病毒自检（HIVST）分发模式可以提高艾滋病毒检测的采用率，并有可能为艾滋病毒治疗和暴露前预防（PrEP）创造需求。我们描述了参与在夸祖鲁-纳塔尔省农村地区进行的 PTP HIVST 分发和抗逆转录病毒/PrEP 推广的集群随机试验的年轻男女对该模式的可接受性和体验。
方法：2019 年 3 月至 9 月期间，24 对经过培训的同伴导航员被随机分配到两种分发 HIVST 包（试剂盒+艾滋病毒预防信息）的方法：同伴朋友在他们的社交网络中分发包以获得少量激励，或同伴导航员直接分发 HIVST 包。第二种方法中，同伴导航员分发信息但不提供 HIVST 试剂盒。对于过程评估，我们对所有试验组中年龄在 18-29 岁的年轻女性（n=30）和男性（n=15）进行了有针对性的半结构式访谈。使用解释主义方法对定性数据进行转录、翻译、手动编码和主题分析。
结果：总体而言，PTP 方法得到了年轻人的认可和重视。参与者对分享他们不会与成年人分享的性健康问题感到舒适。与 HIVST 相结合，同伴（朋友）支持促进了 HIV 检测，并促进了对 HIV 状况披露和治疗的团结。然而，一些年轻人对提供的其他性健康信息表现出有限的兴趣。一些年轻人对被认为是非专业人士的朋友提供的健康信息持谨慎态度，而另一些人则避免与来自社区的同伴导航员分享个人问题。转诊单和青年友好诊所是 PrEP 采用的促进因素。家庭反对、信息有限、每日服用药物和感知风险是 PrEP 采用的主要障碍。
结论：专业方法（同伴导航员）和社交网络方法（朋友）都是接受 HIVST 和性健康信息的可接受方法。对朋友的专业性的怀疑以及对 HIVST 信息材料的过分排他性关注，可能在一定程度上解释了为什么没有同伴导航员支持的 HIVST 试剂盒没有创造 PrEP 的需求。
BMC Public Health. 2023-6-16
BMC Public Health. 2020-1-15
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