US Centers for Disease Control and Prevention, Division of Global, HIV & TB, Nairobi, Kenya.
Ministry of Health Kenya, National AIDS &, STI Control Program, Nairobi, Kenya.
BMC Public Health. 2022 Apr 2;22(1):643. doi: 10.1186/s12889-022-12928-0.
BACKGROUND AND SETTING: About 20% of persons living with HIV aged 15-64 years did not know their HIV status in Kenya, by 2018. Kenya adopted HIV self-testing (HIVST) to help close this gap. We examined the sociodemographic characteristics and outcomes of self-reported users of HIVST as our primary outcome. METHODS: We used data from a 2018 population-based cross-sectional household survey in which we included self-reported sociodemographic and behavioral characteristics and HIV test results. To compare weighted proportions, we used the Rao-Scott χ-square test and Jackknife variance estimation. In addition, we used logistic regression to identify associations of sociodemographic, behavioral, and HIVST utilization. RESULTS: Of the 23,673 adults who reported having ever tested for HIV, 937 (4.1%) had ever self-tested for HIV. There were regional differences in HIVST, with Nyanza region having the highest prevalence (6.4%), p < 0.001. Factors independently associated with having ever self-tested for HIV were secondary education (adjusted odds ratio [aOR], 3.5 [95% (CI): 2.1-5.9]) compared to no primary education, being in the third (aOR, 1.7 [95% CI: 1.2-2.3]), fourth (aOR, 1.6 [95% CI: 1.1-2.2]), or fifth (aOR, 1.8 [95% CI: 1.2-2.7]) wealth quintiles compared to the poorest quintile and having one lifetime sexual partner (aOR, 1.8 [95% CI: 1.0-3.2]) or having ≥ 2 partners (aOR, 2.1 [95% CI: 1.2-3.7]) compared to none. Participants aged ≥ 50 years had lower odds of self-testing (aOR, 0.6 [95% CI: 0.4-1.0]) than those aged 15-19 years. CONCLUSION: Kenya has made progress in rolling out HIVST. However, geographic differences and social demographic factors could influence HIVST use. Therefore, more still needs to be done to scale up the use of HIVST among various subpopulations. Using multiple access models could help ensure equity in access to HIVST. In addition, there is need to determine how HIVST use may influence behavior change towardsaccess to prevention and HIV treatment services.
背景与设置:2018 年,肯尼亚 15-64 岁的 HIV 感染者中约有 20%不知道自己的 HIV 状况。肯尼亚采用 HIV 自我检测(HIVST)来帮助缩小这一差距。我们将自我报告的 HIVST 用户的社会人口统计学特征和结果作为主要结果进行了研究。
方法:我们使用了 2018 年一项基于人群的横断面家庭调查的数据,其中包括自我报告的社会人口统计学和行为特征以及 HIV 检测结果。为了比较加权比例,我们使用了 Rao-Scott χ2 检验和 Jackknife 方差估计。此外,我们还使用逻辑回归来确定社会人口统计学、行为和 HIVST 使用情况之间的关联。
结果:在报告曾经接受过 HIV 检测的 23673 名成年人中,有 937 人(4.1%)曾经进行过 HIV 自我检测。HIVST 在地区间存在差异,其中奈瓦沙地区的患病率最高(6.4%),p<0.001。与未接受过小学教育的人相比,接受过中等教育(调整后的优势比 [aOR],3.5 [95%置信区间:2.1-5.9])、处于第三(aOR,1.7 [95%置信区间:1.2-2.3])、第四(aOR,1.6 [95%置信区间:1.1-2.2])或第五(aOR,1.8 [95%置信区间:1.2-2.7])财富五分位数的人,以及有一个终生性伴侣(aOR,1.8 [95%置信区间:1.0-3.2])或有≥2 个性伴侣(aOR,2.1 [95%置信区间:1.2-3.7])的人,比没有性伴侣的人更有可能进行自我检测。年龄≥50 岁的参与者进行自我检测的可能性较低(aOR,0.6 [95%置信区间:0.4-1.0]),而 15-19 岁的参与者则相反。
结论:肯尼亚在推广 HIVST 方面取得了进展。然而,地理差异和社会人口统计学因素可能会影响 HIVST 的使用。因此,仍需要在不同人群中进一步推广 HIVST 的使用。使用多种获取模式可以帮助确保 HIVST 的获取公平。此外,还需要确定 HIVST 的使用如何影响人们获得预防和 HIV 治疗服务的行为变化。
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