Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
J Int AIDS Soc. 2024 Jun;27(6):e26302. doi: 10.1002/jia2.26302.
INTRODUCTION: To achieve epidemic control of infectious diseases, engaging higher-burden populations with accessible diagnostic services is critical. HIV self-testing (HIVST) is a promising option. METHODS: We implemented an online HIVST programme for key populations across India. Eligible clients were 18 years or older, self-reported a negative or unknown HIV status and reported not taking antiretroviral therapy. Clients who reported a prior HIV diagnosis were not eligible to receive an HIVST kit. HIVST clients received kits via courier or in person at pre-determined pick-up points supported by trained counselling staff. Virtual counsellors engaged clients online and by phone and offered support to register, access, and complete HIVST free of cost. Virtual counsellors supported clients to report results and engage with follow-up services. Follow-up included linking clients with a positive result to confirmatory testing and HIV care services. We assessed programmatic data across HIV continuum outcomes and conducted a qualitative evaluation through interviews with purposively sampled clients. RESULTS: Between 30 June 2021 and 30 September 2022, 5324 clients ordered an HIVST kit (76% men, 13% women, 7% transgender people, 4% unknown gender). Of the 4282 clients reporting results (94% of those who received a kit), 6% screened positive, among whom 72% (n = 184) completed confirmatory testing. Themes from 41 client interviews included satisfaction about the convenience and privacy of services and the discreet nature of kit delivery. Respondents were drawn to the convenience of HIVST and appreciated gaining courage and comfort throughout the process from virtual counsellor support. For respondents who screened positive, challenges to care linkage included fearing judgemental questions from public providers and wanting more time before starting treatment. Clients shared concerns about kit accuracy and suggested that instructional materials be provided with more diverse language options. CONCLUSIONS: Web-based HIVST services with tailored support appeared to facilitate HIV service access and engagement of harder-to-reach populations across India. Assistance from a community-oriented counsellor proved important to overcome literacy barriers and mistrust in order to support the HIVST process and service linkage. Learnings can inform global efforts to improve the critical step of diagnosis in achieving epidemic control for HIV and other infectious diseases.
简介:为了实现传染病的流行控制,让负担较重的人群能够获得便捷的诊断服务至关重要。HIV 自我检测(HIVST)是一种很有前途的选择。
方法:我们在印度为重点人群实施了一项在线 HIVST 计划。符合条件的客户年龄在 18 岁或以上,自我报告 HIV 阴性或未知状态,且未接受抗逆转录病毒治疗。报告曾被诊断为 HIV 的客户没有资格获得 HIVST 检测包。HIVST 客户通过快递或在培训过的咨询人员支持的预先确定的取件点亲自领取检测包。虚拟咨询员通过在线和电话与客户联系,提供免费注册、访问和完成 HIVST 的支持。虚拟咨询员支持客户报告结果并与后续服务联系。后续服务包括将阳性结果的客户与确认检测和 HIV 护理服务联系起来。我们评估了整个 HIV 连续体结果的项目数据,并通过对有针对性抽样的客户进行访谈进行了定性评估。
结果:在 2021 年 6 月 30 日至 2022 年 9 月 30 日期间,有 5324 名客户订购了 HIVST 检测包(76%为男性,13%为女性,7%为跨性别者,4%为未知性别)。在报告结果的 4282 名客户中(收到检测包的客户的 94%),有 6%的客户检测结果呈阳性,其中 72%(n=184)完成了确认检测。41 名客户访谈的主题包括对服务的便利性和隐私性以及检测包交付的保密性感到满意。受访者对 HIVST 的便利性很感兴趣,并从虚拟咨询员的支持中获得了勇气和安慰。对于检测结果呈阳性的受访者,在寻求护理方面的挑战包括担心公共提供者的评判性问题,以及希望在开始治疗前有更多时间。受访者担心检测包的准确性,并建议提供更多语言选择的使用说明。
结论:具有针对性支持的基于网络的 HIVST 服务似乎促进了印度更难接触到的人群获得 HIV 服务和参与。来自社区导向的咨询员的帮助对于克服读写障碍和不信任至关重要,以支持 HIVST 过程和服务联系。这些经验教训可以为改善全球努力提供信息,以改善诊断这一关键步骤,从而实现艾滋病毒和其他传染病的流行控制。
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