Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.
J Int AIDS Soc. 2022 Jun;25(6):e25937. doi: 10.1002/jia2.25937.
South African men are underrepresented in HIV testing and treatment services. Secondary distribution of oral HIV self-test (HIVST) kits by women living with HIV (WLHIV) to their male partners (i.e. index partner HIVST) may increase men's testing and treatment but has been understudied.
Between March and July 2021, we evaluated the effectiveness of index partner HIVST versus the standard of care (SOC) (invitations for men's facility-based testing) on men's testing in a 1:1 randomized control trial. Eligibility criteria included: WLHIV; ≥18 years of age; attending one of four high-density rural clinics; have a working cell phone; and self-reported having a primary male partner of unknown serostatus. The primary outcome was the proportion of WLHIV reporting that her partner tested for HIV within 3 months after enrolment.
We enrolled 180 WLHIV and 176 completed an endline survey (mean age = 35 years, 15% pregnant, 47% unmarried or non-cohabiting). In the HIVST arm, 78% of male partners were reported to have tested for HIV versus 55% in SOC (RR = 1.41; 95% CI = 1.14-1.76). In the HIVST arm, nine men were reactive with HIVST (14% positivity), six were confirmed HIV positive with standard testing (67%) and all of those started antiretroviral therapy (ART), and four HIV-negative men started pre-exposure prophylaxis (PrEP) (5%). In SOC, six men were diagnosed with HIV (12% positivity), 100% started ART and seven HIV-negative men started PrEP (16%). One case of verbal intimate partner violence was reported in the HIVST arm.
Secondary distribution of HIVST to partners of WLHIV was acceptable and effective for improving HIV testing among men in rural South Africa in our pilot study. Interventions are needed to link reactive HIVST users to confirmatory testing and ART.
南非男性在接受艾滋病毒检测和治疗服务方面的代表性不足。艾滋病毒阳性女性（PLHIV）将口服艾滋病毒自检（HIVST）试剂盒分发给其男性伴侣（即，指标伴侣 HIVST），这可能会增加男性的检测和治疗，但这种做法研究不足。
2021 年 3 月至 7 月期间，我们在一项 1:1 随机对照试验中评估了指标伴侣 HIVST 与标准护理（SOC）（邀请男性到医疗机构进行检测）对男性检测的效果。纳入标准包括：PLHIV；年龄≥18 岁；在四家高密度农村诊所之一就诊；有一部工作手机；并自述有一个未知血清状况的主要男性伴侣。主要结局是报告其伴侣在入组后 3 个月内接受艾滋病毒检测的 PLHIV 的比例。
我们招募了 180 名 PLHIV，其中 176 名完成了期末调查（平均年龄 35 岁，15%怀孕，47%未婚或未同居）。在 HIVST 组中，有 78%的男性伴侣报告接受了艾滋病毒检测，而在 SOC 组中这一比例为 55%（RR=1.41；95%CI=1.14-1.76）。在 HIVST 组中，有 9 名男性 HIVST 检测呈阳性（阳性率 14%），6 名男性经标准检测确诊 HIV 阳性（阳性率 67%），所有这些人都开始接受抗逆转录病毒治疗（ART），4 名 HIV 阴性男性开始接受暴露前预防（PrEP）（5%）。在 SOC 组中，有 6 名男性被诊断出 HIV 阳性（阳性率 12%），100%开始接受 ART，7 名 HIV 阴性男性开始接受 PrEP（16%）。在 HIVST 组中报告了 1 例口头亲密伴侣暴力案件。
在我们的试点研究中，向 PLHIV 的伴侣分发 HIVST 是可以接受的，并且有效地提高了南非农村地区男性的艾滋病毒检测率。需要采取干预措施，将 HIVST 阳性者与确证检测和 ART 联系起来。
