Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States.
CUNY Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States.
Front Public Health. 2023 Jan 6;10:880070. doi: 10.3389/fpubh.2022.880070. eCollection 2022.
BACKGROUND: In sub-Saharan Africa, truckers and female sex workers (FSWs) have high HIV risk and face challenges accessing HIV testing. Adding HIV self-testing (HIVST) to standard of care (SOC) programs increases testing rates. However, the underlying mechanisms are not fully understood. HIVST may decrease barriers (inconvenient clinic hours, confidentiality concerns) and thus we would expect a greater impact among those not accessing SOC testing (barriers prevented previous testing). As a new biomedical technology, HIVST may also be a cue to action (the novelty of a new product motivates people to try it), in which case we might expect the impact to be similar by testing history. METHODS: We used data from two randomized controlled trials evaluating the announcement of HIVST availability text-message to male truckers ( = 2,260) and FSWs ( = 2,196) in Kenya. Log binomial regression was used to estimate the risk ratio (RR) for testing ≤ 2 months post-announcement in the intervention vs. SOC overall and by having tested in the previous 12-months (12m-tested); and we assessed interaction between the intervention and 12m-tested. We also estimated risk differences (RD) per 100 and tested additive interaction using linear binomial regression. RESULTS: We found no evidence that 12m-tested modified the HIVST impact. Among truckers, those in the intervention were 3.1 times more likely to test than the SOC ( < 0.001). Although testing was slightly higher among those not 12m-tested (RR = 3.5, = 0.001 vs. RR = 2.7, = 0.020), the interaction was not significant ( = 0.683). Among FSWs, results were similar (unstratified RR = 2.6, < 0.001; 12m-tested: RR = 2.7, < 0.001; not 12m-tested: RR = 2.5, < 0.001; interaction = 0.795). We also did not find significant interaction on the additive scale (truckers: unstratified RD = 2.8, < 0.001; 12m-tested RD = 3.8, = 0.037; not 12m-tested RD = 2.5, = 0.003; interaction = 0.496. FSWs: unstratified RD = 9.7, < 0.001; 12m-tested RD = 10.7, < 0.001, not 12m-tested RD = 9.1, < 0.001; interaction = 0.615). CONCLUSION: The impact of HIVST was not significantly modified by 12m-tested among truckers and FSWs on the multiplicative or additive scales. Announcing the availability of HIVST likely served primarily as a cue to action and testing clinics might maximize the HIVST benefits by holding periodic HIVST events to maintain the cue to action impact rather than making HIVST continually available.
背景：在撒哈拉以南非洲地区，卡车司机和女性性工作者（FSWs）具有较高的 HIV 风险，并且在接受 HIV 检测方面面临挑战。将 HIV 自我检测（HIVST）添加到标准护理（SOC）方案中会提高检测率。然而，其潜在机制尚不完全清楚。HIVST 可能会降低障碍（不方便的诊所时间、保密性问题），因此我们预计在未接受 SOC 检测的人群中（以前的障碍阻止了检测），其影响会更大。作为一种新的生物医学技术，HIVST 也可能是一种行动的线索（新产品的新颖性促使人们尝试使用它），在这种情况下，我们可能期望根据检测史，其影响是相似的。
方法：我们使用了两项评估肯尼亚男性卡车司机（=2260）和 FSWs（=2196）HIVST 可用性公告的随机对照试验的数据。使用对数二项式回归来估计干预组与 SOC 整体相比，在公告后 ≤2 个月内检测的风险比（RR），并按过去 12 个月内检测（12m-检测）进行分层；并评估了干预措施和 12m-检测之间的交互作用。我们还使用线性二项式回归估计了每 100 个风险差异（RD）和测试加性交互作用。
结果：我们没有发现 12m-检测改变了 HIVST 的影响。在卡车司机中，干预组比 SOC 组更有可能接受检测（<0.001）。尽管未接受 12m 检测的人检测率略高（RR=3.5，<0.001；RR=2.7，<0.020），但交互作用不显著（=0.683）。在 FSWs 中，结果相似（未分层 RR=2.6，<0.001；12m-检测：RR=2.7，<0.001；未接受 12m 检测：RR=2.5，<0.001；交互作用=0.795）。我们也没有在加性尺度上发现显著的交互作用（卡车司机：未分层 RD=2.8，<0.001；12m-检测 RD=3.8，<0.037；未接受 12m 检测 RD=2.5，<0.003；交互作用=0.496。FSWs：未分层 RD=9.7，<0.001；12m-检测 RD=10.7，<0.001，未接受 12m 检测 RD=9.1，<0.001；交互作用=0.615）。
结论：在卡车司机和 FSWs 中，12m-检测并没有显著改变 HIVST 的影响，无论是在乘法还是加法尺度上。宣布 HIVST 的可用性可能主要起到了行动的线索作用，检测诊所可能通过定期举办 HIVST 活动来保持线索作用的影响，而不是持续提供 HIVST，从而最大限度地发挥 HIVST 的益处。
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