Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Int AIDS Soc. 2023 May;26(5):e26100. doi: 10.1002/jia2.26100.
INTRODUCTION: The United States Centers for Disease Control and Prevention currently recommends HIV screening at least annually among sexually active gay, bisexual and other men who have sex with men (MSM), but only half report being tested in the past year in the United States. As HIV self-test kits are becoming more available around the United States via web and app-based interventions, it is important to understand who is willing and able to order them. This analysis sought to better understand predictors of free HIV self-test kit utilization among MSM in M-cubed, an HIV prevention mobile app intervention trial in Atlanta, Detroit and New York City. METHODS: We conducted an exploratory secondary analysis of self-report and in-app data collected from the intervention arm of the M-Cubed study from 24 January 2018 to 31 October 2019. Behavioural, demographic and other potential predictors of HIV self-test ordering were identified from Social Cognitive Theoretical underpinnings of the app, and from the literature. Significant predictor variables in bivariate analyses were considered for inclusion in the empiric multivariable model. Demographic variables chosen a priori were then added to a final model estimating adjusted prevalence ratios (aPR). RESULTS: Over half of the 417 intervention participants ordered an HIV self-test kit during the study. In bivariate analyses, ordering a kit was associated with HIV testing history, plans to get tested and reported likelihood of getting tested. In the final model, participants were more likely to order a kit if they reported plans to get tested in the next 3 months (aPR = 1.58, 95% CI: 1.18-2.11) or had not tested for HIV in the past 3 months (aPR = 1.38, 95% CI: 1.13-1.70). There was no difference in HIV self-test kit ordering by income, race/ethnicity or age. CONCLUSIONS: HIV testing is an important tool in ending the HIV epidemic and must be accessible and frequent for key populations. This study demonstrates the effectiveness of HIV self-test kits in reaching populations with suboptimal testing rates and shows that self-testing may supplement community-based and clinical testing while helping overcome some of the structural barriers that limit access to annual HIV prevention services for MSM.
引言：美国疾病控制与预防中心目前建议性活跃的男同性恋、双性恋和其他与男性发生性关系的男性（MSM）至少每年进行一次 HIV 筛查，但在美国，只有一半的人报告在过去一年中进行了检测。随着 HIV 自检试剂盒在美国通过网络和基于应用程序的干预措施越来越多地提供，了解谁愿意并有能力订购这些试剂盒非常重要。本分析旨在更好地了解 M-cubed 中 MSM 中免费 HIV 自检试剂盒使用的预测因素，M-cubed 是亚特兰大、底特律和纽约市的一项 HIV 预防移动应用程序干预试验。 方法：我们对 2018 年 1 月 24 日至 2019 年 10 月 31 日从 M-Cubed 研究干预组收集的自我报告和应用程序内数据进行了探索性二次分析。从应用程序的社会认知理论基础以及文献中确定了与 HIV 自检订购相关的行为、人口统计学和其他潜在预测因素。在单变量分析中具有统计学意义的预测变量被认为包含在经验多变量模型中。然后，预先选择的人口统计学变量被添加到最后一个模型中，以估计调整后的患病率比（aPR）。 结果：在 417 名干预参与者中，超过一半在研究期间订购了 HIV 自检试剂盒。在单变量分析中，订购试剂盒与 HIV 检测史、检测计划和报告的检测可能性相关。在最终模型中，如果参与者报告计划在未来 3 个月内进行检测（aPR = 1.58，95%CI：1.18-2.11）或过去 3 个月内未进行 HIV 检测（aPR = 1.38，95%CI：1.13-1.70），他们更有可能订购试剂盒。收入、种族/族裔或年龄对 HIV 自检试剂盒的订购没有影响。 结论：HIV 检测是结束 HIV 流行的重要工具，必须为重点人群提供方便和频繁的检测。这项研究表明 HIV 自检试剂盒在接触检测率不理想的人群方面非常有效，并表明自检可能补充社区和临床检测，同时帮助克服限制 MSM 获得年度 HIV 预防服务的一些结构性障碍。
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