Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, 4 Bath Road, Belgravia, Harare, Zimbabwe.
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
BMC Infect Dis. 2023 Oct 17;22(Suppl 1):973. doi: 10.1186/s12879-023-08624-y.
There is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations.
At clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings.
May to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34-0.93) and those previously married aOR0.56 (0.34-0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28-3.13), 2.55 (1.28-5.07), 2.76 (1.48-5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96-0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47-17.41), 3.38 (2.03-5.62) and 2.23 (1.38-3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09-0.92).
Most testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations.
关于不同的 HIV 自我检测（HIVST）和由提供者提供的检测选择以及相关因素，客户偏好的数据有限。我们探讨了不同人群对口服液基自我检测（OFBST）、血基自我检测（BBST）和由提供者提供的血基检测（PDBBT）的偏好。
在向一般人群提供 HIV 检测服务的诊所（1 家城市诊所，1 家农村诊所）、寻求自愿男性包皮环切术（VMMC，1 家诊所）的男性和性工作者（FSW，1 家诊所）中，客户可以选择使用 OFBST、BBST 或 PDBBT 进行检测。在进行预测试问卷调查时，收集了人口统计学和检测史的信息。在收集自我检测试剂盒两周后，参与者回答了一份问卷。我们使用逻辑回归来确定选择的预测因素。我们还进行了 20 次深入访谈，以了解定量发现的背景。
2019 年 5 月至 6 月，我们招募了 1244 名参与者，其中 249 名（20%）、251 名（20%）、244 名（20%）和 500 名（40%）分别在城市普通诊所、农村诊所、VMMC 诊所和 FSW 诊所就诊。有一半（n=619，50%）选择了 OFBST，440 名（35%）和 185 名（15%）分别选择了 BBST 和 PDBBT。在比较选择 HIVST（OFBST 和 BBST 组合）与不选择的多变量分析中，与已婚参与者相比，从未结婚的参与者 aOR 0.57（95%CI 0.34-0.93）和以前结婚的参与者 aOR0.56（0.34-0.93）更不可能选择 HIVST。HIVST 偏好随着教育程度的提高而增加，aOR 2.00（1.28-3.13）、2.55（1.28-5.07）、2.76（1.48-5.14），分别为普通、高级和高等教育相对于无/初等教育。HIVST 偏好随着年龄的增加而降低，aOR 0.97（0.96-0.99）。与农村参与者相比，城市参与者更有可能选择 HIVST，aOR 9.77（5.47-17.41）、3.38（2.03-5.62）和 2.23（1.38-3.61），分别为 FSW、城市普通和 VMMC 参与者。比较选择 OFBST 和选择 BBST 的参与者，文化程度较低的参与者不太可能选择口服液检测，aOR 0.29（0.09-0.92）。
大多数检测客户选择了 OFBST，其次是 BBST，最后是 PDBBT。那些自我评估健康状况较差的人更有可能选择 PDBBT，这可能有助于建立联系。结果表明，为了满足不同人群的需求，继续提供所有策略非常重要，这可能有助于预测 HIVST 试剂盒的库存，并针对不同人群的需求调整 HIVST 计划。
