伊犁州男男性行为者基于互联网的“1+1”HIV自助检测分析

目的了解基于互联网的"1+1"艾滋病病毒(HIV)自助检测(含指尖血快速检测及尿液传递检测)在伊犁州男男性行为者(MSM)中的可接受性和有效性。方法为满足伊犁州MSM在匿名状态下既快速获得检测结果,又得到专业准确检测及服务的要求,开发了基于互联网的"1+1"HIV自助检测,与伊犁州当地社区组织合作,免费发放160份"1+1"HIV自助检测服务包。MSM拿到服务包后,阅读知情同意书,按照操作说明书进行血液自检,并自行采集尿液,填写调查问卷。将尿液样本和调查问卷邮寄至伊犁州疾病预防控制中心艾滋病检测实验室。结果共收到133份尿液样本及调查问卷,回收率83.1%;91.7%(122例)的年龄≤40岁,汉族占54.1%(72人),维吾尔族占35.3%(47人),本科以上学历者占29.3%(39人)。男男同性恋者占79.7%(106人),双性恋者占20.3%(27人)。17.0%(18/106)的男男同性恋者及33.3%(9/27)的双性恋者在最近6个月内发生过无保护性行为。133人指尖血快检阳性率为10.5%(14人),尿液抗体检测阳性率为14.3%(19人)。19位HIV尿液抗体检测阳性者中,有15随访成功并进行了复检和确证,其中12人为新诊断HIV感染者;此外,17位HIV尿液抗体检测阳性者,86位HIV抗体检测阴性者匿名查询了检测结果。结论通过消除传统医务人员主动提供咨询检测和自愿咨询检测的实名制障碍,"1+1"HIV自助检测服务可帮助专业医疗机构人员与MSM建立起相应的衔接,有效发现潜在的HIV感染者,并对初筛阳性者进行及时的随访和确证。     

HIV-1/2抗体自我检测的应用现状

艾滋病病毒(HIV)自我检测(简称自检)是现有HIV检测服务的补充途径。目前,全球共有4种快速检测试剂被批准用于HIV自检,16个国家有相关的政策支持HIV自检或者(和)销售HIV快速检测试剂用于HIV自检。HIV自检的开展可能受HIV自检试剂的准确性、检测前后的咨询、自检费用等因素的影响。为了解HIV自检的准确性、可行性、接受性等,从国内外开展情况、方法学评价、社会学评价对HIV自检进行综述。     

血液/口腔黏膜渗出液/尿液HIV抗体快速检测试剂的性能评价

目的构建血液、口腔黏膜渗出液(OMT)、尿液HIV抗体快速评价盘,评价3种血液,2种OMT和1种尿液HIV抗体快速检测试剂的性能。方法用血液、OMT、尿液国家参考品,实验室评价盘(包括实验室基础盘、实验室干扰盘、实验室稀释系列盘、实验室精密度盘),商业阳转血清盘,对6种(3种血液,2种OMT和1种尿液)HIV抗体快速检测试剂进行评价,肉眼判读结果,并用金标免疫层析试纸读数仪测定相应的GOD值。结果 1)6种试剂的阴性参考品符合率均为20/20,HIV-1阳性参考品符合率均为18/18,3种血液和2种OMT试剂的HIV-2阳性参考品符合率均为2/2。2)3种血液试剂的阳性样本符合率和阴性样本符合率均为40/40,2种OMT试剂的阳性样本符合率均为40/40,阴性样本符合率分别为40/40和38/40。尿液试剂的阳性样本符合率和阴性样本符合率为30/30。3)3种血液试剂的分析灵敏度均为2/3,2种OMT试剂的分析灵敏度分别为3/5和0/5,尿液试剂的分析灵敏度为3/5。4)3种血液试剂的分析特异性均为45/45,2家OMT试剂的分析特异性分别为45/45和36/45,尿液试剂的分析特异性为45/45。5)GOD结果显示6家试剂的批内精密度在7.8%～44.0%之间。结论 6家试剂的阴性参考品符合率,阳性参考品符合率,阳性样本符合率、阴性样本符合率均较好。1家OMT试剂的分析灵敏度和分析特异性较差,6种试剂的批内精密度存在差异。     

深圳市男男性行为者HIV口腔黏膜渗出液快速检测试剂的使用情况及影响因素

目的 分析深圳市MSM利用口腔黏膜渗出液快速检测（简称口腔自检）试剂进行HIV检测的使用情况及相关影响因素。方法 2019年9月至2021年12月,通过微信网络、同伴动员等方式招募深圳市≥18岁且过去1年内发生过同性口交或肛交性行为的男性,利用在线问卷收集目标人群的社会人口学信息、性行为特征、口腔自检试剂使用情况等信息。结果 共纳入841名研究对象,其中128名（15.22%）曾做过HIV口腔自检。口腔自检试剂获取途径主要为网店购买和社会组织发放,分别占41.41%(53/128)、32.03%(41/128)。多因素Logistic分析结果显示,大专及以上学历（OR=2.51,95%CI:1.06～5.97）、通过网络寻找性伴（OR=3.13,95%CI:1.24～7.92）是MSM使用HIV口腔自检试剂的促进因素。结论 深圳市MSM HIV口腔自检率偏低,文化程度、性伴寻找方式可影响该人群HIV口腔自检试剂的使用。建议开通基于互联网的HIV口腔自检试剂申请渠道,提高HIV口腔自检的覆盖面以期进一步扩大HIV检测。     

男男性行为者对HIV-1唾液快检试剂说明书的理解力评价

目的评价男男性行为者(MSM)对艾滋病病毒(HIV)唾液快速检测试剂说明书的理解力。方法设计调查问卷,包括基本信息和15道针对HIV唾液快检试剂说明书中关键信息的问题。在自愿咨询检测点,MSM阅读说明书(无时间限制)并填写调查问卷。结果招募225人,其中33.78%(76人)答对11～15道题,充分理解关键信息;66.22%(149人)答对1～10道题不等,对关键信息理解不充分。9道问题的回答正确率≤70%,其中问题"患有牙周炎时是否可用本试剂检测HIV"最低,仅13.33%。单因素分析结果显示,MSM对关键信息的理解受民族和HIV唾液快检试剂的知晓情况的影响。多因素分析结果显示,与汉族相比,少数民族对说明书的理解更充分[比值比(OR)=5.206];与了解HIV唾液快检试剂者相比,未听说过者对说明书的理解更不充分(OR=0.224)。结论 MSM对HIV唾液快检试剂的说明书理解不充分,与民族和HIV唾液快检试剂的知晓情况有关。当用于艾滋病自检时,自检结果的准确性可能会受影响,建议合理修改说明书。     

互联网+自我检测HIV的MSM特征和感染因素

目的了解互联网+自我检测模式下,首次接受艾滋病病毒(HIV)检测的男男性行为者(MSM)的特征及其感染危险因素。方法与北京当地社区组织合作,通过互联网+自我检测模式,为有HIV检测意向的MSM提供免费HIV快速检测试剂。通过快递收到HIV快速检测试剂后,按操作说明要求进行自我检测,并将HIV自我检测结果反馈回HIV自检试剂领取网站。结果 2015-2016年共发放检测试剂5 072份,其中491例未反馈HIV自检结果,未反馈自检结果的比例为9.7%。4 581例反馈结果的网络自检MSM中,680例为既往阳性/重复检测,809例既往进行过HIV检测却不知晓检测结果,3 092例为首次HIV检测者。互联网+自我检测MSM具有受教育程度高、多性伴和肛交行为中未能使用安全套等特点。首次自检MSM的HIV阳性率为7.9%(244/3 092),最近1个月内肛交行为活跃(≥5次)与HIV感染相关[比值比(OR)=1.50,95%可信区间(CI):1.04~2.16],25岁(OR=1.98,95%CI:1.35~2.91)、初中及以下受教育程度(OR=1.47,95%CI:1.06~2.04)和最近一个月未全程使用安全套(OR=1.36,95%CI:1.00~1.85)首次自检者的HIV感染率较高。结论与社区组织合作的互联网+自我检测模式可有效提高HIV检测服务的可及性。     

互联网上销售的HIV抗体快速检测试剂物理性能和灵敏度调查

目的了解互联网上销售艾滋病病毒(HIV)抗体快速检测试剂的现状,评价试剂的物理性能和分析灵敏度,分析用于自我检测时可能存在的问题。方法通过比较互联网上购买HIV抗体快速检测试剂的包装、预期用途、样本类型等,评价其物理性能;通过检测最低检出限样本,评价其分析灵敏度。结果 32种互联网上销售的HIV抗体快速检测试剂包装中9种有图片式说明材料(9/32),31种有样本采集装置(31/32)。说明书中2种的预期用途为无偿献血现场初筛(2/32),5种为自愿咨询检测(5/32),1种为消费者自检(1/32);25种结果解释中没有后续处理方法(25/32);13种互联网销售的HIV抗体血液快速检测剂没有指尖血采集步骤(13/18),1种只能检测血清和血浆(1/18)。29种互联网上销售HIV抗体快速检测试剂检测最低检出限样本均为反应性结果(29/29)。结论专业实验室使用的试剂用于自我检测时存在的问题:HIV血液抗体快速检测试剂没有配备采血针、没有指尖血采集步骤;没有图片式说明材料;结果解释中没有介绍后续处理方法等。     

HIV检测模式在男男性行为者中的选择偏好及影响因素

目的分析男男性行为者(MSM)对艾滋病病毒(HIV)检测模式的选择偏好及影响因素,为扩大HIV检测提供参考依据。方法 2018年6月至2019年5月,珠海社会组织以互联网+社交媒体为平台,招募参与HIV自我检测(自检)和基于医疗点HIV快速检测(快检)的MSM,收集其人口学和性行为特征等信息,并检测HIV抗体和梅毒抗体。采用χ~2检验和非条件多因素Logistic回归分析参与两种HIV检测模式MSM的选择偏好及影响因素。结果共1 046名MSM纳入此次分析,年龄中位数为28(24～34)岁,其中参与HIV自检440人,医疗点HIV快检606人。多因素Logistic回归分析结果显示,大专及以上[比值比(OR)=2.889,95%可信区间(CI):2.151～3.880]、学生(OR=2.153,95%CI:1.346～3.444)、近6个月与男性发生肛交者(OR=1.766,95%CI:1.291～2.415)更倾向于HIV自检;已婚者(OR=0.461,95%CI:0.213～0.994),自报性取向为异性恋者(OR=0.459,95%CI:0.280～0.751)更倾向于医疗点HIV快检。结论参与珠海市社会组织两种HIV检测模式的MSM是相对独立的群体。对于大专及以上、学生及性活跃的同性恋MSM,应大力推广HIV自检模式,同时还应继续巩固基于医疗点的HIV快检模式,以满足不同特征人群的检测需求。     

HIV抗体快速检测试剂在北京MSM中应用的真实性评价

目的评价艾滋病病毒（HIV）抗体快速检测试剂,应用于男男性行为人群（MSM）中检测的真实性。方法用两种HIV抗体口腔黏膜渗出液快速检测试剂和指尖血HIV抗体快速检测试剂,对MSM进行快速检测。同时每位调查对象抽取静脉血,用酶联免疫吸附试验（ELISA）检测HIV抗体,阳性者用蛋白免疫印迹法（WB）进行确认检测。以ELISA和WB结果作为金标准,将快速检测结果与之相比较。结果 HIV抗体口腔黏膜渗出液快速检测试剂1的阴性样本检测错误百分比为6.4%（6/94）,阳性样本检测错误百分比为0.1%（1/800）。HIV抗体口腔黏膜渗出液快速检测试剂2的阴性样本检测错误百分比为25.2%（26/103）,阳性样本检测错误百分比为0（0/795）。指尖血检测的阴性样本检测错误百分比为0（0/197）,阳性样本检测错误百分比为0.1%（1/1595）。结论两种口腔黏膜渗出液快速检测试剂都可能导致一部分HIV感染者漏检。在选择口腔黏膜渗出液快速检测试剂时需要进行多方比较和评价,同时加强对开展HIV抗体快速检测的MSM志愿者的培训。对HIV抗体口腔黏膜渗出液快速检测结果的咨询显得尤为重要。     

网络购买HIV快速检测试剂用于自我检测人群特征

目的了解网络购买艾滋病病毒(HIV)快速检测试剂用于自我检测人群的特征,为进一步扩大基于互联网的HIV检测服务,促进人群主动检测提供依据和参考。方法随机选取网络购买HIV快速检测试剂的1 000人作为调查对象,在邮寄给其的快递盒内放入项目简介卡发布问卷调查信息。利用网络平台,设计、录入网络版"网络购买HIV快速检测试剂用于自我检测调查问卷",调查对象通过QQ,微信在电脑或手机端完成调查问卷。结果共有591人完成网络问卷调查,其中男性512人,女性79人;年龄中位数25岁(15～50岁);未婚占78.7%(465人);大专或本科以上文化占66.2%(391人);自由职业者及大学生人群是主要购买人群,分别占36.0%(213人)及26.2%(155人);月收入在2 000～5 000元之间的占53.0%(313人)。异性恋人群占57.5%(340人),男男同性恋人群占27.2%(161人),双性恋人群占15.2%(90人)。此外,64.7%(220/340)的异性恋人群、69.6%(112/161)的男男同性恋人群及72.2%(65/90)的双性恋人群在最近6个月内发生过无保护性行为。50.9%(301/591)的调查对象在自我检测后会和客服人员联系进行咨询。28.8%(170人)的调查对象在自我检测后,选择去疾病预防控制中心或医院寻求进一步确证及咨询服务。结论网络购买HIV快速检测试剂用于自我检测的人群大部分是未婚年轻男性,他们受教育程度较高,多数为异性恋,且收入属中上等,在最近6个月内发生过无保护性行为,对该人群提供检测后的专业咨询服务非常重要。     

Are women more likely to self-test? A short report from an acceptability study of the HIV self-testing kit in South Africa

This study assessed the acceptability of, as well as the facilitators of and barriers to the HIV self-testing kit in the Gauteng province, South Africa. An exploratory qualitative cross-sectional study was conducted using focus group discussions (FGDs) among a sample of 118 respondents selected from the Braamfontein and Soweto areas of Johannesburg. Sixteen FGDs were conducted in order to assess the acceptability of the HIV self-testing kit. Respondent groups were segmented according to area (Soweto or Braamfontein), gender (male or female), age (20–34 and 35–49 years of age) and HIV testing status (have previously tested for HIV or have never tested for HIV) in order to achieve maximum variability. The main advantage identified was that the self-testing kit allows for privacy and confidentiality with regard to HIV status, and does not require a visit to a health facility – two of the main barriers to current HIV counselling and testing uptake. However, respondents, predominantly males, were concerned about the lack of counselling involved, which they thought could lead to suicide ideation among testers. The HIV self-testing kit was found to be acceptable among the majority of respondents. However, there is still a need for follow-up services for self-testers. The idea of a hotline for telephonic counselling within the self-testing model seemed to be favourable among many respondents and is an alternative to traditional face-to-face counselling, although some respondents felt that this was not sufficient.     

An innovative vending machine-based HIV testing and intervention service in China: anonymous urine collection kits distributed at universities

ABSTRACT

To find more effective test and intervention measures, and to achieve the first 90 of the 90–90–90 target, this study was conducted for the first time to develop and assess an innovative HIV anonymous urine test service-based vending machine and Internet at universities of China. From June to December 2016, 11 vending machines were placed in 7 pilot universities in Beijing, Sichuan, Yunnan and Heilongjiang provinces. A total of 957 HIV urine collection kits were dispensed free and also through vending machines and 378 (39.5%) urine samples were returned and 376 (99.5%) of them were qualified to be tested for HIV antibody in professional laboratories. Participants searched for confidential test results using an ID code online. Only seven (1.86%) urine samples were positive. Monitoring data showed 67.8% (255/376) participants searched for test results online, 72.2% of kits were purchased in dormitory buildings and 27.8% were purchased in teaching buildings and 88.9% were purchased between 21:00 and 24:00. In conclusion, this study analyzes the acceptability, feasibility and effectiveness of HIV testing and intervention service.     

Perceptions and attitudes towards acceptability of HIV self-testing among female sex workers in Selibe Phikwe,Botswana

Background: Sub-Saharan Africa accounts for 71% of the global burden of HIV infection. For the general population of Botswana, the estimated HIV prevalence is 18.5%; for female sex workers it is 61.9%. This study explored and documented female sex workers’ perceptions and attitudes towards the acceptability of HIV self-testing in Selibe Phikwe, north-eastern Botswana.

Methods: Purposive convenience sampling and snowballing approaches were used to recruit 17 participants into the study which was carried out in collaboration with a community-based organisation, the Silence Kills Support Group. Two focus group discussions and five in-depth interviews were conducted. Information was collected on female sex workers’ awareness of HIV self-testing, their willingness to use it, their preferred distribution model, and their preferred test kit. Themes and subthemes that emerged were interpreted based on the Integrated Behavioural Model.

Results: HIV self-testing (HIVST) was not known to most participants. Participants expressed negative attitude towards HIVST due to a lack of knowledge and confidence to carry out self-testing independently. Participants preferred facility-based services and a blood test over HIVST. Inadequate post-test counselling and lack of assisted HIVST were among their major concerns. Raising community awareness of HIVST through education was suggested.

Conclusion: Improving the uptake of HIVST will require community sensitization, the availability of counselling services, close follow-ups, and the introduction of assisted HIVST approaches.     

Correlates of requesting home HIV self-testing kits on online social networks among African-American and Latino men who have sex with men

High levels of HIV stigma are one of the main difficulties in engaging African-American and Latino men who have sex with men (MSM) in HIV testing. The availability of home HIV test and the possibility of self-testing in private may improve uptake and counteract stigma. This paper sought to determine the correlates of requesting home HIV test kits among a sample of MSM social media users. The odds of participants requesting a test kit were significantly associated with using social networks to seek sexual partners (aOR: 2.47, 95% CI: 1.07–6.06) and thinking it is easier to use social networks for seeking sexual partners (1.87, 1.2–3.12), uncertain HIV status (4.29, 1.37–14.4), and having sex under the influence of alcohol (2.46, 1.06–5.77). Participants who had not been tested for more than 6 months were more likely to request a test kit than those who were tested in the past 6 months (2.53, 1.02–6.37). Participants who frequently talked to others about having sex with men online were less likely to request a test kit (0.73, 0.56–0.92). By reaching people over social media and offering them access to test kits, we were able to reach at-risk individuals who were uncertain about their HIV status and had not been regularly tested. The findings of the study will help to inform future HIV testing interventions.     

What happened to home HIV test collection kits? Intent to use kits,actual use,and barriers to use among persons at risk for HIV infection

Through sequential cross-sectional surveys, we examined intent to use home HIV test collection kits, actual use and barriers to use among persons at high risk for HIV infection. Interest in kits was assessed in the 1995-96 HIV Testing Survey (HITS, n=1683). Kit use, knowledge of kits and barriers to use were assessed in the 1998-99 HITS (n=1788), after kits had become widely available. When asked to choose among future testing options, 19% of 1995-96 participants intended to use kits. Untested participants were more likely than previously tested HIV-negative participants to choose kits for their next HIV test (p < 0.001). Among 1998-99 participants, only 24 (1%) had used kits; 46% had never heard of kits. Predictors of not knowing about kits included never having been HIV tested and black or Latino race. Common reasons for not using kits among participants aware of home test kits were concerns about accuracy, lack of in-person counselling and cost. Despite high rates of anticipated use, kits have had minimal impact on the testing behaviour of persons at high risk for HIV infection. Increasing awareness of kits, reducing price and addressing concerns about kit testing procedures may increase kit use, leading to more HIV testing by at-risk individuals.     

Adolescents’ and caregivers’ perceptions of caregiver-provided testing and HIV self-testing using oral mucosal transudate tests in Zimbabwe: a short report

ABSTRACT

Uptake of HIV testing remains lower among children and adolescents compared to adults. This study explored adolescents’ perceptions of HIV self-testing (HIVST) and caregivers’ perceptions of testing their children using an oral mucosal transudate (OMT) rapid HIV test (caregiver-provided testing). We conducted 31 interviews with adolescents aged 16–18 years and caregivers of children aged 2–15 years who received an OMT test. Participants described barriers to HIV testing including lack of privacy and the potential for discrimination by community members towards children and adolescents who received an HIV test. Most participants felt caregiver-provided testing and HIVST could address these barriers through increased privacy. Some participants expressed worry about their ability to correctly perform the OMT and their anxious reactions to a positive result. Counseling and assistance from health care workers were viewed as ways to alleviate concerns. Concerns shaped participants’ preferences for facility-based HIVST and caregiver-provided testing. Findings demonstrate HIVST performed by adolescents and caregiver-provided testing could increase the uptake of HIV testing. Concerns related to being able to test correctly and the availability of post-test counseling must be addressed in any future delivery mechanisms.     

Willingness to distribute free rapid home HIV test kits and to test with social or sexual network associates among men who have sex with men in the United States

Peer-driven HIV prevention strategies can be effective in identifying high-risk persons with undiagnosed infections. Besides individual self-testing, other potential uses of rapid home HIV test kits include distributing them, and testing with others within one's social or sexual networks. We sought to identify factors associated with the willingness to engage in these alternative activities among men who have sex with men (MSM) in the United States. From May to October 2014, we surveyed 828 HIV-negative or unknown status MSM about multiple aspects of rapid home HIV testing. A greater proportion indicated being likely to distribute free oral fluid (OF) tests compared to free finger-stick blood (FSB) tests (91% versus 79%), and almost three-fourths (72%) reported being likely to test with their friends or sex partners in the future. MSM not identifying as homosexual/gay were less willing to distribute OF tests, and those with lower educational attainment were more willing to distribute FSB tests. MSM unaware of their HIV status were less likely to report potentially testing with others using free rapid home HIV tests compared to those who were HIV-negative. Finally, MSM willing to self-test were more likely to report future test kit distribution, and those willing to distribute kits were more likely to report potentially testing with others. Engaging individuals with positive attitudes towards these strategies in prevention efforts could help increase HIV testing levels among MSM. A greater understanding of the potential public health impact of rapid home HIV test kits is necessary.     

A Global Review of HIV Self-testing: Themes and Implications

HIV self-test kits may have the potential to increase testing rates around the globe, and thereby lead to reductions in HIV-related incidence and mortality. However, the effectiveness of these self-test kits and the issues surrounding self-testing have been greatly debated in recent years. We conducted a literature review on the acceptability, feasibility, and effectiveness of HIV self-testing (HST) around the world. Of the 28 articles abstracted, several themes of HST were explored, including behavioral risk compensation, presence of counseling, uses of HST, ability to perform the self-test, sensitivity and specificity, concordance with confirmatory testing, perceptions surrounding HST, instruction and supervision, and cost. Overall, this literature review found that this diverse group of participants generally performed HST correctly with a few exceptions, were accepting of the test if available at a relatively low cost, and preferred the oral-based HST over the blood-based test.     

HIV testing preferences among long distance truck drivers in Kenya: a discrete choice experiment

Providing HIV testing services to truck drivers in Africa is crucial but has proven challenging. The introduction of HIV self-testing promises to provide expanded service delivery options for clients, potentially increasing demand for services and expanding coverage – especially important for high-risk and difficult-to-reach populations. This study examines the preferences regarding HIV testing service delivery models, among long distance truck drivers to identify testing services that would appeal to this population. Using a discrete choice experiment, this study examines the drivers of choice regarding HIV counselling and testing among 305 truck drivers recruited from two roadside wellness clinics along major trucking routes in Kenya. Participants made trade-offs between characteristics of HIV testing service delivery models by making hypothetical choices in a series of paired HIV testing scenarios. Conditional logit models were used to identify the HIV testing characteristics driving the selection of preferred scenarios, as well as determine whether preferences interact with individual characteristics – especially HIV testing history. Participants preferred free, provider-administered HIV testing at a roadside clinic, using a finger-prick test, with in-person counselling, undertaken in the shortest possible time. The strongest driver of choice was the cost of the test. Those who had never tested previously preferred oral testing and telephonic counselling, while those who were not regular testers favoured clinic based – over self-testing. The results of this study indicate that for the majority of participants – most of whom had tested before – the existing services offered at roadside clinics were the preferred service delivery model. The introduction of oral self-testing increases the options available to truck drivers and may even improve testing uptake for some, especially among those who have never tested before. However, these findings suggest the impact on HIV testing uptake of introducing oral self-testing may be limited in this population.