Malawi Liverpool Wellcome Trust, Blantyre, Malawi.
Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.
BMC Infect Dis. 2024 Apr 2;22(Suppl 1):979. doi: 10.1186/s12879-024-09231-1.
HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has largely been oral-fluid-based. We investigated whether users preferred blood-based (i.e. using blood sample derived from a finger prick) or oral fluid-based HIVST in rural and urban Malawi.
At clinics providing HIV testing services (n = 2 urban; n = 2 rural), participants completed a semi-structured questionnaire capturing sociodemographic data before choosing to test using oral-fluid-based HVST, blood-based HIVST or provider-delivered testing. They also completed a self-administered questionnaire afterwards, followed by a confirmatory test using the national algorithm then appropriate referral. We used simple and multivariable logistic regression to identify factors associated with preference for oral-fluid or blood-based HIVST.
July to October 2018, N = 691 participants enrolled in this study. Given the choice, 98.4% (680/691) selected HIVST over provider-delivered testing. Of 680 opting for HIVST, 416 (61.2%) chose oral-fluid-based HIVST, 264 (38.8%) chose blood-based HIVST and 99.1% (674/680) reported their results appropriately. Self-testers who opted for blood-based HIVST were more likely to be male (50.3% men vs. 29.6% women, p < 0.001), attending an urban facility (43% urban vs. 34.6% rural, p = 0.025) and regular salary-earners (49.5% regular vs. 36.8% non-regular, p = 0.012). After adjustment, only sex was found to be associated with choice of self-test (adjusted OR 0.43 (95%CI: 0.3-0.61); p-value < 0.001). Among 264 reporting blood-based HIVST results, 11 (4.2%) were HIV-positive. Blood-based HIVST had sensitivity of 100% (95% CI: 71.5-100%) and specificity of 99.6% (95% CI: 97.6-100%), with 20 (7.6%) invalid results. Among 416 reporting oral-fluid-based HIVST results 18 (4.3%) were HIV-positive. Oral-fluid-based HIVST had sensitivity of 88.9% (95% CI: 65.3-98.6%) and specificity of 98.7% (95% CI: 97.1-99.6%), with no invalid results.
Offering both blood-based and oral-fluid-based HIVST resulted in high uptake when compared directly with provider-delivered testing. Both types of self-testing achieved high accuracy among users provided with a pre-test demonstration beforehand. Policymakers and donors need to adequately plan and budget for the sensitisation and support needed to optimise the introduction of new quality-assured blood-based HIVST products.
HIV 自我检测（HIVST）可以使用口腔液或基于血液的检测。研究表明，与基于机构的服务相比，人们更倾向于自我检测。尽管有低成本的基于血液的 HIVST 选择，但迄今为止，撒哈拉以南非洲的 HIVST 实施主要是基于口腔液。我们调查了农村和城市马拉维的用户是否更喜欢基于血液（即使用手指刺伤获得的血液样本）或口腔液的 HIVST。
在提供 HIV 检测服务的诊所（城市 2 个；农村 2 个），参与者在选择使用口腔液 HIVST、基于血液的 HIVST 或提供者提供的检测之前，完成了一份半结构化问卷，该问卷收集了社会人口统计学数据。他们还在之后完成了一份自我管理的问卷，然后使用国家算法进行确认测试，然后进行适当的转介。我们使用简单和多变量逻辑回归来确定与选择口腔液或血液 HIVST 相关的因素。
2018 年 7 月至 10 月，共有 691 名参与者参加了这项研究。在有选择的情况下，98.4%（680/691）选择了 HIVST 而不是提供者提供的检测。在选择 HIVST 的 680 人中，416 人（61.2%）选择了口腔液 HIVST，264 人（38.8%）选择了血液 HIVST，99.1%（674/680）报告了他们的结果。选择血液 HIVST 的自我测试者更有可能是男性（50.3%男性对 29.6%女性，p<0.001），在城市设施就诊（43%城市对 34.6%农村，p=0.025）和固定工资收入者（49.5%固定对 36.8%非固定，p=0.012）。调整后，只有性别被发现与自我检测的选择有关（调整后的 OR 0.43（95%CI：0.3-0.61）；p 值<0.001）。在报告血液 HIVST 结果的 264 人中，有 11 人（4.2%）呈 HIV 阳性。血液 HIVST 的敏感性为 100%（95%CI：71.5-100%），特异性为 99.6%（95%CI：97.6-100%），有 20 个（7.6%）无效结果。在报告口腔液 HIVST 结果的 416 人中，有 18 人（4.3%）呈 HIV 阳性。口腔液 HIVST 的敏感性为 88.9%（95%CI：65.3-98.6%），特异性为 98.7%（95%CI：97.1-99.6%），没有无效结果。
与提供者提供的检测相比，直接比较，提供血液和口腔液 HIVST 都会导致高吸收率。两种类型的自我检测都在事先提供预测试演示的情况下实现了用户的高准确性。政策制定者和捐助者需要充分计划和预算，以开展宣传和提供支持，从而优化新的质量保证血液 HIVST 产品的推出。
