Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
Department of Global Health, University of Washington, Seattle, Washington, USA.
J Int AIDS Soc. 2024 Jul;27 Suppl 1(Suppl 1):e26298. doi: 10.1002/jia2.26298.
INTRODUCTION: Assisted partner services (APS) is an effective strategy for increasing HIV testing, new diagnosis, and linkage to care among sexual partners of people living with HIV (PLWH). APS can be resource intensive as it requires community tracing to locate each partner named and offer them testing. There is limited evidence for the effectiveness of offering HIV self-testing (HIVST) as an option for partner testing within APS. METHODS: We conducted a cluster randomized controlled trial comparing provider-delivered HIV testing (Standard APS) versus offering partners the option of provider-delivered testing or HIVST (APS+HIVST) at 24 health facilities in Western Kenya. Facilities were randomized 1:1 and we conducted intent-to-treat analyses using Poisson generalized linear mixed models to estimate intervention impact on HIV testing, new HIV diagnoses, and linkage to care. All models accounted for clustering at the clinic level and new diagnoses and linkage models were adjusted for individual-level age, sex, and income a priori. RESULTS: From March to December 2021, 755 index clients received APS and named 5054 unique partners. Among these, 1408 partners reporting a prior HIV diagnosis were not eligible for HIV testing and were excluded from analyses. Of the remaining 3646 partners, 96.9% were successfully contacted for APS and tested for HIV: 2111 (97.9%) of 2157 in the APS+HIVST arm and 1422 (95.5%) of 1489 in the Standard APS arm. In the APS+HIVST arm, 84.6% (1785/2111) tested via HIVST and 15.4% (326/2111) received provider-delivered testing. Overall, 16.7% of the 3533 who tested were newly diagnosed with HIV (APS+HIVST = 357/2111 [16.9%]; Standard APS = 232/1422 [16.3%]). Of the 589 partners who were newly diagnosed, 90.7% were linked to care (APS+HIVST = 309/357 [86.6%]; Standard APS = 225/232 [97.0%]). There were no significant differences between the two arms in HIV testing (relative risk [RR]: 1.02, 95% CI: 0.96-1.10), new HIV diagnoses (adjusted RR [aRR]: 1.03, 95% CI: 0.76-1.39) or linkage to care (aRR: 0.88, 95% CI: 0.74-1.06). CONCLUSIONS: There were no differences between APS+HIVST and Standard APS, demonstrating that integrating HIVST into APS continues to be an effective strategy for identifying PLWH by successfully reaching and HIV testing >95% of elicited partners, newly diagnosing with HIV one in six of those tested, >90% of whom were linked to care. CLINICAL TRIAL NUMBER: NCT04774835.
简介：辅助伴侣服务（APS）是提高 HIV 检测率、新诊断率和 HIV 感染者（PLWH）性伴侣获得治疗的有效策略。由于需要社区追踪来找到每个被提名的伴侣并为他们提供检测，APS 可能需要大量资源。在 APS 中提供 HIV 自我检测（HIVST）作为伴侣检测的一种选择，其有效性证据有限。
方法：我们在肯尼亚西部的 24 个卫生机构进行了一项以诊所为单位的随机对照试验，比较了提供提供者检测（标准 APS）与为伴侣提供提供者检测或 HIVST 选项（APS+HIVST）的效果。设施按照 1:1 进行随机分组，我们使用泊松广义线性混合模型进行意向治疗分析，以估计干预对 HIV 检测、新的 HIV 诊断和获得治疗的影响。所有模型均考虑了诊所层面的聚类，新诊断和获得治疗模型均根据个体的年龄、性别和收入进行了预先调整。
结果：2021 年 3 月至 12 月，755 名索引患者接受了 APS 服务，并为 5054 名独特的伴侣命名。其中，1408 名报告先前 HIV 诊断的伴侣不符合 HIV 检测条件，未纳入分析。在剩余的 3646 名伴侣中，96.9%（2157 名中的 2111 名）成功联系到 APS 并接受了 HIV 检测：2111 名（APS+HIVST 组的 97.9%）和 1489 名（标准 APS 组的 95.5%）。在 APS+HIVST 组中，84.6%（2111 名中的 1785 名）通过 HIVST 检测，15.4%（2111 名中的 326 名）接受提供者检测。总体而言，接受检测的 3533 人中，16.7%（APS+HIVST 组=357/2111 [16.9%]；标准 APS 组=232/1422 [16.3%]）新诊断为 HIV。在新诊断的 589 名伴侣中，90.7%（APS+HIVST 组=309/357 [86.6%]；标准 APS 组=225/232 [97.0%]）获得了治疗。两个组之间在 HIV 检测（相对风险 [RR]：1.02，95%CI：0.96-1.10）、新的 HIV 诊断（调整后的 RR [aRR]：1.03，95%CI：0.76-1.39）或获得治疗（aRR：0.88，95%CI：0.74-1.06）方面均无显著差异。
结论：APS+HIVST 和标准 APS 之间没有差异，这表明将 HIVST 整合到 APS 中仍然是一种有效的策略，可以通过成功接触和 HIV 检测 95%以上的被提名伴侣来识别 PLWH，对接受检测的伴侣中每六分之一新诊断为 HIV，其中 >90%获得了治疗。
临床试验注册号：NCT04774835。
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