Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
Research Center for Epidemic Prevention and One Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Int AIDS Soc. 2022 Mar;25(3):e25897. doi: 10.1002/jia2.25897.
INTRODUCTION: Being aware of one's HIV-positive status can help reduce unprotected sex and promote early treatment seeking. Therefore, HIV self-test (HIVST) programs may help control the HIV epidemic by case finding. The aims of this study were to determine the effect of HIVST programs on HIV case finding, time to confirmatory diagnosis and factors associated with linkage to confirmatory diagnosis in Taiwan. METHODS: The Centers for Disease Control in Taiwan initiated HIVST programs and imported 78,000 self-test kits in 2017 and 2019. Clients paid 7 US dollars for a self-test kit at facilities, vending machines or online. The programs set up an HIVST logistics management system; each kit had a unique barcode for monitoring the programs because purchases were anonymous. When clients provided their test results with photo barcodes online or at HIV/AIDS-designated hospitals, they received full monetary reimbursement. We conducted a quasi-experimental interrupted time-series (ITS) analysis that covered a period of 60 months from 2015 to 2019. We enrolled a retrospective cohort of reported HIV cases with initial positive results from HIVST programs between March 2017 and July 2020. RESULTS: The ITS analysis included data from 10,976 reported HIV cases from 2015 to 2019. The HIVST-positive cohort included 386 reported HIV cases, of whom 99.7% were males and 97% were men who have sex with men (MSM); the median age was 28 years. The ITS analysis showed a positive slope change in the number of reported HIV cases immediately in the beginning implementation month (coefficient: 51.09 in 2017 and 3.62 in 2019), but there was a significant decrease over time. It was a negative slope change by 9.52 cases per month in 2017 and 5.56 cases per month in 2019. In the HIVST-positive cohort, three of five individuals linked to HIV confirmatory diagnosis within 1 month after a positive self-test result, and an early linkage to confirmatory diagnosis was associated with HIVST disclosure (adjusted OR = 6.5; 95% CI: 3.9-10.6). CONCLUSIONS: HIVST programs were associated with an increase in HIV case finding. Our findings suggest that countries with a high incidence of HIV among MSM populations should offer multichannel HIVST services.
简介：了解自己的 HIV 阳性状况有助于减少无保护性行为并促进早期治疗。因此，HIV 自我检测（HIVST）计划可能通过病例发现来帮助控制 HIV 疫情。本研究的目的是确定 HIVST 计划对 HIV 病例发现、确诊时间以及与确诊后关联的因素的影响，这些都是在台湾进行的。
方法：台湾疾病管制署于 2017 年和 2019 年启动了 HIVST 计划，并进口了 78,000 份自检试剂盒。客户可在设施、自动售货机或在线支付 7 美元购买一份自检试剂盒。该计划建立了 HIVST 物流管理系统；每个试剂盒都有一个独特的条码，用于监测计划，因为购买是匿名的。当客户在线或在艾滋病定点医院提供带有照片条码的检测结果时，他们会获得全额报销。我们进行了一项准实验性中断时间序列（ITS）分析，该分析涵盖了 2015 年至 2019 年的 60 个月。我们招募了一个回顾性队列，该队列包括 2017 年 3 月至 2020 年 7 月期间 HIVST 计划初始阳性结果的报告 HIV 病例。
结果：ITS 分析包括 2015 年至 2019 年期间报告的 10976 例 HIV 病例数据。HIVST 阳性队列包括 386 例报告的 HIV 病例，其中 99.7%为男性，97%为男男性行为者（MSM）；中位年龄为 28 岁。ITS 分析显示，在实施计划的第一个月立即出现报告 HIV 病例数量的正斜率变化（2017 年的系数为 51.09，2019 年为 3.62），但随着时间的推移呈显著下降趋势。2017 年每月减少 9.52 例，2019 年每月减少 5.56 例。在 HIVST 阳性队列中，有五分之三的人在阳性自检结果后一个月内与 HIV 确诊诊断相关联，早期与确诊诊断相关联与 HIVST 披露相关（调整后的 OR=6.5；95%CI：3.9-10.6）。
结论：HIVST 计划与 HIV 病例发现的增加有关。我们的研究结果表明，在 HIV 发病率较高的男男性行为者人群中，国家应提供多渠道的 HIVST 服务。
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