Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands.
Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, Public Health Service South Limburg, Heerlen, Netherlands.
AIDS Behav. 2024 Oct;28(10):3338-3349. doi: 10.1007/s10461-024-04415-x. Epub 2024 Jul 4.
This review identifies which elements of home-based comprehensive sexual health care (home-based CSH) impacted which key populations, under which circumstances. A realist review of studies focused on home-based CSH with at least self-sampling or self-testing HIV and additional sexual health care (e.g., treatment, counseling). Peer-reviewed quantitative and qualitative literature from PubMed, Embase, Cochrane Register of Controlled Trials, and PsycINFO published between February 2012 and February 2023 was examined. The PRISM framework was used to systematically assess the reach of key populations, effectiveness of the intervention, and effects on the adoption, implementation, and maintenance within routine sexual health care. Of 730 uniquely identified records, 93 were selected for extraction. Of these studies, 60% reported actual interventions and 40% described the acceptability and feasibility. Studies were mainly based in Europe or North America and were mostly targeted to MSM (59%; 55/93) (R). Overall, self-sampling or self-testing was highly acceptable across key populations. The effectiveness of most studies was (expected) increased HIV testing. Adoption of the home-based CSH was acceptable for care providers if linkage to care was available, even though a minority of studies reported adoption by care providers and implementation fidelity of the intervention. Most studies suggested maintenance of home-based CSH complementary to clinic-based care. Context and mechanisms were identified which may enhance implementation and maintenance of home-based CSH. When providing the individual with a choice of testing, clear instructions, and tailored dissemination successful uptake of STI and HIV testing may increase. For implementers perceived care and treatment benefits for clients may increase their willingness to implement home-based CSH. Therefore, home-based CSH may determine more accessible sexual health care and increased uptake of STI and HIV testing among key populations.
本综述旨在确定家庭综合性行为健康护理（家庭 CSH）的哪些要素对哪些关键人群产生了影响，以及在哪些情况下产生了影响。本研究对至少包括自我采样或自我检测 HIV 以及其他性行为健康护理（如治疗、咨询）的家庭 CSH 进行了以实证为基础的综述。研究人员检索了 2012 年 2 月至 2023 年 2 月期间在 PubMed、Embase、Cochrane 对照试验登记处和 PsycINFO 上发表的同行评审的定量和定性文献，使用 PRISM 框架系统评估了关键人群的覆盖范围、干预措施的有效性，以及对常规性行为健康护理中干预措施的采用、实施和维持的影响。在 730 份独特的记录中，有 93 份被选中进行提取。这些研究中，60%报告了实际干预措施，40%描述了可接受性和可行性。这些研究主要基于欧洲或北美，主要针对男男性行为者（59%；55/93）（R）。总体而言，自我采样或自我检测在关键人群中具有高度的可接受性。大多数研究的有效性（预期）是增加了 HIV 检测。如果能够与护理机构建立联系，家庭 CSH 的采用对于护理提供者来说是可以接受的，尽管少数研究报告了护理提供者的采用和干预措施的实施一致性。大多数研究表明，家庭 CSH 可以作为诊所护理的补充，维持其运行。研究还确定了可能增强家庭 CSH 实施和维持的背景和机制。当为个人提供检测选择、清晰的说明和定制的传播途径时，性传播感染和 HIV 检测的接受度可能会增加。对于实施者来说，他们对客户的护理和治疗益处的认知可能会增加他们实施家庭 CSH 的意愿。因此，家庭 CSH 可能会为关键人群提供更便捷的性行为健康护理，并提高性传播感染和 HIV 检测的接受度。
