Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.
ICAP at Columbia University, New York, NY, United States.
Front Public Health. 2022 Nov 9;10:911932. doi: 10.3389/fpubh.2022.911932. eCollection 2022.
INTRODUCTION: Clinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral fluid vs. blood-based HIVST to elucidate prior trial results and inform testing programs. METHODS: Participants were recruited from a HIVST randomized controlled trial in Nakuru County, Kenya, which aimed to test the effect of choice between oral HIVST and facility-based testing compared to standard-of-care on HIV testing among truck drivers. We conducted in-depth interviews (IDIs) with purposively sampled trial participants who declined HIV testing at baseline or who were offered access to oral fluid HIVST and chose not to pick up the kit during follow-up. IDIs were conducted with all consenting participants. We first describe IDI participants compared to the other study participants, assessing the statistical significance of differences in characteristics between the two samples and then describe preferences, beliefs, and attitudes about HIVST biospecimen type expressed in the IDIs. RESULTS: The final sample consisted of 16 men who refused HIV testing at baseline and 8 men who did not test during follow-up. All IDI participants had tested prior to study participation; mean number of years since last HIV test was 1.55, vs. 0.98 among non-IDI participants ( = 0.093). Of the 14 participants who answered the question about preferred type of HIVST, nine preferred blood-based HIVST, and five, oral HIVST. Preference varied by study arm with four of five participants who answered this question in the Choice arm and five of nine in the SOC arm preferring blood-based HIVST. Six key themes characterized truckers' views about test type: (1) Rapidity of return of test results. (2) Pain and fear associated with finger prick. (3) Ease of use. (4) Trust in test results; (5) fear of infection by contamination; and (6) Concerns about HIVST kit storage and disposal. CONCLUSION: We found no general pattern in the themes for preference for oral or blood-based HIVST, but if blood-based HIVST had been offered, some participants in the Choice arm might have chosen to self-test. Offering choices for HIVST could increase testing uptake.
简介：撒哈拉以南非洲的临床试验表明，艾滋病病毒自我检测（HIVST）可以提高难以接触到的人群的检测率。然而，试验大多仅评估口腔液 HIVST。我们描述了对口腔液与基于血液的 HIVST 的偏好，以阐明先前的试验结果并为检测计划提供信息。 方法：参与者是从肯尼亚纳库鲁县的一项 HIVST 随机对照试验中招募的，该试验旨在测试在卡车司机中，与标准护理相比，在选择口腔 HIVST 与机构内检测之间进行选择对 HIV 检测的影响。我们对在基线时拒绝 HIV 检测或在随访期间选择不领取试剂盒但获得了口腔液 HIVST 机会的有意愿参加试验的参与者进行了深入访谈（IDI）。所有同意的参与者都进行了 IDI。我们首先描述 IDI 参与者与其他研究参与者的比较，评估两个样本之间特征差异的统计学意义，然后描述 IDI 中表达的对 HIVST 生物样本类型的偏好、信念和态度。 结果：最终样本由 16 名在基线时拒绝 HIV 检测的男性和 8 名在随访期间未检测的男性组成。所有 IDI 参与者在研究参与前都进行过 HIV 检测；上次 HIV 检测后的平均年数为 1.55 年，而非 IDI 参与者为 0.98 年（ = 0.093）。在回答关于首选 HIVST 类型的问题的 14 名参与者中，有 9 名更喜欢基于血液的 HIVST，5 名更喜欢口腔 HIVST。偏好因研究臂而异，在选择臂中回答这个问题的 5 名参与者中有 4 名和 SOC 臂中的 9 名参与者中有 5 名更喜欢基于血液的 HIVST。卡车司机对测试类型的看法有 6 个关键主题：（1）测试结果返回的速度。（2）与手指刺痛相关的疼痛和恐惧。（3）易用性。（4）对测试结果的信任；（5）对感染的恐惧；（6）对 HIVST 试剂盒储存和处置的担忧。 结论：我们没有发现对口腔或基于血液的 HIVST 偏好的主题的一般模式，但如果提供基于血液的 HIVST，选择臂中的一些参与者可能会选择自我检测。提供 HIVST 的选择可以提高检测率。
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