LoveYourself, Inc, 715 Anglo Bldg., Shaw Blvd, 1550, Mandaluyong City, Philippines.
Family Planning Organization of the Philippines, Inc, Iloilo Chapter - Rajah Community Center, 2F Dulalia Building, Rizal St, 5000, Iloilo City, Iloilo City Proper, Philippines.
BMC Public Health. 2022 Feb 21;22(1):366. doi: 10.1186/s12889-022-12705-z.
INTRODUCTION: The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. METHODS: We did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits. RESULTS: HIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01-4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46-7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15-2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32-0.62]). CONCLUSIONS: HIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.
简介:菲律宾是全球艾滋病疫情上升最快的国家,可供选择的艾滋病检测方法有限,跨性别女性(TGW)和男男性行为者(MSM)中的艾滋病检测率仍然很低,尤其是在 COVID-19 大流行期间。由于 HIV 自我检测(HIVST)和基于技术的方法可以协同扩大艾滋病检测的覆盖面,我们旨在评估社区主导的在线 HIVST 示范的结果,并探讨与 HIVST 相关行为和结果相关的因素。
方法:我们对 2020 年 3 月至 11 月期间在菲律宾西米沙鄢地区参与 HIVST 示范的 MSM 和 TGW 进行了二次数据分析。我们回顾了人口统计学、性行为和背景相关变量的数据。使用多变量逻辑回归,我们检验了上述协变量与两个主要结果之间的关联,即选择直接辅助 HIVST(DAH)和愿意二次分发试剂盒。
结果:共发放 647 份 HIVST 试剂盒(590 名 MSM,57 名 TGW),54.6%为首次检测者,10.4%选择 DAH,46.1%愿意分发给同伴。报告率很高(99.3%),反应率为 7.6%。虽然预防(100%)和护理(85.7%)的联系很高,但暴露前预防(PrEP)(0.3%)和抗逆转录病毒治疗(ART)(51.0%)的启动率有限。没有不良事件的报告。那些有工作、最近有肛交、选择 DAH、不愿意二次分发、在最小或没有隔离限制的情况下接受 HIVST 的人,反应率明显更高。在过去一年中有三个或更多性伴侣的人(优势比[OR]为 2.01[CI 为 1.01-4.35])和在最大隔离限制期间接受 HIVST 的人(OR 为 4.25[CI 为 2.46-7.43]),选择 DAH 的可能性更高。在城市地区的人(OR 为 1.64[CI 为 1.15-2.36])更愿意分享,而首次检测者(OR 为 0.45[CI 为 0.32-0.62])则较低。
结论:HIVST 可以有效地接触到难以接触到的人群。虽然人们对在线无辅助方法有需求,但仍应提供 DAH。应通过将这些服务去中心化到社区组织,来扩大 PrEP 和当天 ART 的覆盖面。差异化的服务提供是关键,以满足关键人群在他们所处的动态地理和社会文化背景下的偏好和价值观。
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