中国 HIV 自我检测的实践和潜在作用：系统评价和荟萃分析。

BACKGROUND: HIV self-testing (HIVST) is recommended by the World Health Organization as a valid approach to routine HIV testing services. The scale of HIVST use has gradually been expanded in China over the past 5 years. To take a closer look at the role of HIVST in China, we reviewed the promotion and application of HIVST within China. OBJECTIVE: The main objective of this study was to systematically analyze the proportion of past use and actual uptake of HIVST within China. Moreover, we aimed to quantify the effect of HIVST on HIV prevention and treatment. METHODS: In all, 5 medical databases and 2 registration systems, including PubMed, Web of Science, MEDLINE, WanFang, China National Knowledge Internet, ClinicalTrials.gov, and the Chinese Clinical Trial Registry were systematically searched for studies reporting the prevalence of HIVST use from January 1, 2010, to December 25, 2021. Meta-analyses of the pooled proportion estimates were carried out by the meta-package in R software (version 4.1.2). Statistical heterogeneity among the studies was estimated using Cochran Q test and the inconsistency index (I). RESULTS: A total of 50 studies were included in our systematic review. The estimated pooled prevalence of HIVST use in China was 29.9% (95% CI 22.5%-37.9%). Among individuals who have ever used HIVST, 47.5% (95% CI 37.2%-57.8%) were tested for HIV for the first time. The pooled reactive rate of HIVST was 4.2% (95% CI 3.1%-5.8%). When HIVST revealed a reactive result, 81.3% (95% CI 70.9%-91.6%) of individuals sought medical care. CONCLUSIONS: In recent times, HIVST has become a valuable tool for HIV prevention in China. The widespread use of HIVST in non-men who have sex with men populations needs to be endorsed and promoted. The long-term applications of HIVST and the potential consequences of self-financing of HIVST in China have yet to be explored. TRIAL REGISTRATION: PROSPERO CRD42022304846; https://tinyurl.com/54d9pxy8.

背景：世界卫生组织建议将 HIV 自我检测（HIVST）作为常规 HIV 检测服务的有效方法。在过去的 5 年中，中国逐渐扩大了 HIVST 的使用规模。为了更深入地了解 HIVST 在我国的作用，我们回顾了中国境内 HIVST 的推广和应用情况。

目的：本研究的主要目的是系统分析中国过去使用和实际采用 HIVST 的比例，并定量评估 HIVST 对 HIV 预防和治疗的效果。

方法：系统检索了 2010 年 1 月 1 日至 2021 年 12 月 25 日期间，PubMed、Web of Science、MEDLINE、万方、中国国家知识基础设施、ClinicalTrials.gov 和中国临床试验注册中心等 5 个医学数据库和 2 个注册系统中报道 HIVST 使用情况的研究。采用 R 软件（版本 4.1.2）中的 meta 包对汇总比例估计值进行荟萃分析。采用 Cochran Q 检验和不一致指数（I）评估研究间的统计学异质性。

结果：本系统评价共纳入 50 项研究。中国 HIVST 的估计总使用率为 29.9%（95%CI：22.5%-37.9%）。在曾经使用过 HIVST 的人群中，有 47.5%（95%CI：37.2%-57.8%）首次进行了 HIV 检测。HIVST 的总反应率为 4.2%（95%CI：3.1%-5.8%）。当 HIVST 结果呈阳性时，81.3%（95%CI：70.9%-91.6%）的人会寻求医疗服务。

结论：近年来，HIVST 已成为中国 HIV 预防的有力工具。需要支持和推广在非男男性行为人群中广泛使用 HIVST。中国尚未探索 HIVST 的长期应用及其自我融资的潜在后果。

试验注册：PROSPERO CRD42022304846；https://tinyurl.com/54d9pxy8。