Measuring the performance of HIV self-testing at private pharmacies in Kenya: a cross-sectional study.
Measuring the performance of HIV self-testing at private pharmacies in Kenya: a cross-sectional study.
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测量肯尼亚私人药房中艾滋病毒自我测试的表现：一项横断面研究。
DOI：
10.1002/jia2.26177
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发表时间：
2023-10
影响因子：
6
通讯作者：
中科院分区：
文献类型：
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作者：
艾滋病毒自我检测（HIVST）有可能支持私人药房每日口服暴露前预防（PrEP）的提供，但许多国家指南尚未批准艾滋病毒自我检测用于PrEP的分发。在肯尼亚，药店提供者被允许提供艾滋病毒感染检测，但往往没有提供快速诊断检测所需的认证。我们对肯尼亚私人药店提供的hiv - st与RDT （PrEP提供的护理标准）相比的表现进行了评估，以便为扩大PrEP使用hiv - st的决策提供信息。在基苏木县的20家药店，我们对药房提供者（药剂师和制药技术人员）进行了关于基于血液的hiv使用和客户援助（如有要求）的培训。我们招募了购买性健康和生殖健康相关产品（如避孕套）的药房客户，并招募了那些自我报告有与艾滋病毒风险相关行为的≥18岁的客户。登记的客户在相关提供者咨询的情况下接受艾滋病毒治疗，然后由经认证的艾滋病毒检测服务（HTS）顾问进行RDT。在RDT之前，药房提供者和客户独立解释hiv检测结果（结果仅由HTS咨询师解释）。我们计算了药房提供者提供的hiv - st与HTS辅导员管理的RDT的敏感性和特异性。在2022年3月至6月期间，我们筛选了1691名客户，登记了1500名；64%（954/1500）为女性，中位年龄26岁（IQR 22-31）。我们还招募了40家供应商；42%（17/40）是药店老板，他们的工作经验中位数为6年（IQR 4-10）。大多数（79%,1190/1500）的患者要求医务人员协助治疗艾滋病毒感染者，医务人员与每位艾滋病毒感染者的平均时间为20分钟（IQR 15-43）。当由提供者（98.5%,95% CI 97.8%, 99.1%）和客户（98.8%,95% CI 98.0%, 99.3%）解释时，药房提供者提供的hiv - st的敏感性很高，在这种情况下hiv - st的特异性也很高（提供者解释：96.9%,95% CI 89.2%, 99.6%；客户解释：93.8%,95% CI 84.8%, 98.3%）。与国家艾滋病毒检测算法相比，肯尼亚私人药店的提供者提供的基于血液的艾滋病毒检测方法表现良好。这些发现表明，基于血液的艾滋病毒检测可能是一种有用的工具，可以支持在私人药房和潜在的其他基于社区的交付环境中开始和继续PrEP。
HIV self‐testing (HIVST) has the potential to support daily oral pre‐exposure prophylaxis (PrEP) delivery in private pharmacies, but many national guidelines have not approved HIVST for PrEP dispensing. In Kenya, pharmacy providers are permitted to deliver HIVST, but often do not have the required certification to deliver rapid diagnostic testing (RDT). We estimated the performance of provider‐delivered HIVST compared to RDT, the standard of care for PrEP delivery, at private pharmacies in Kenya to inform decisions on the use of HIVST for PrEP scale‐up. At 20 pharmacies in Kisumu County, we trained pharmacy providers (pharmacists and pharmaceutical technologists) on blood‐based HIVST use and client assistance (if requested). We recruited pharmacy clients purchasing sexual and reproductive health‐related products (e.g. condoms) and enrolled those ≥18 years with self‐reported behaviours associated with HIV risk. Enrolled clients received HIVST with associated provider counselling, followed by RDT by a certified HIV testing services (HTS) counsellor. Pharmacy providers and clients independently interpreted HIVST results prior to RDT (results interpreted only by the HTS counsellor). We calculated the sensitivity and specificity of pharmacy provider‐delivered HIVST compared to HTS counsellor‐administered RDT. Between March and June 2022, we screened 1691 clients and enrolled 1500; 64% (954/1500) were female and the median age was 26 years (IQR 22–31). We additionally enrolled 40 providers; 42% (17/40) were pharmacy owners and their median years of experience was 6 (IQR 4–10). The majority (79%, 1190/1500) of clients requested provider assistance with HIVST and providers spent a median of 20 minutes (IQR 15–43) with each HIVST client. The sensitivity of provider‐delivered HIVST at the pharmacy was high when interpreted by providers (98.5%, 95% CI 97.8%, 99.1%) and clients (98.8%, 95% CI 98.0%, 99.3%), as was the specificity of HIVST in this setting (provider‐interpretation: 96.9%, 95% CI 89.2%, 99.6%; client‐interpretation: 93.8%, 95% CI 84.8%, 98.3%). When compared to the national HIV testing algorithm, provider‐delivered blood‐based HIVST at private pharmacies in Kenya performed well. These findings suggest that blood‐based HIVST may be a useful tool to support PrEP initiation and continuation at private pharmacies and potentially other community‐based delivery settings.
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影响因子：
8.1
作者：
Indravudh PP;Fielding K;Chilongosi R;Nzawa R;Neuman M;Kumwenda MK;Nyirenda R;Johnson CC;Taegtmeyer M;Desmond N;Hatzold K;Corbett EL
通讯作者：
Corbett EL
影响因子：
--
作者：
Nakambale, Hilma N.;Roche, Stephanie D.;Mogere, Peter;Omollo, Victor;Kuo, Alexandra P.;Stergachis, Andy;Baeten, Jared M.;Bukusi, Elizabeth;Ngure, Kenneth;Mugambi, Melissa Latigo;Ortblad, Katrina F.
通讯作者：
Ortblad, Katrina F.
影响因子：
16.1
作者：
Nel, Annalene;van Niekerk, Neliette;Rosenberg, Zeda
通讯作者：
Rosenberg, Zeda
影响因子：
5.2
作者：
Kiptinness, Catherine;Naik, Paulami;Thuo, Nicholas;Malen, Rachel C.;Dettinger, Julia C.;Pintye, Jillian;Rafferty, Maeve;Jomo, Edwin;Nyamasyo, Nicky;Wood, Tony;Isabelli, Paul;Morris, Sarah;Hattery, David;Stergachis, Andy;Were, Daniel;Sharma, Monisha;Ngure, Kenneth;Mugambi, Melissa Latigo;Ortblad, Katrina F.
通讯作者：
Ortblad, Katrina F.
影响因子：
15.1
作者：
Jamil MS;Eshun-Wilson I;Witzel TC;Siegfried N;Figueroa C;Chitembo L;Msimanga-Radebe B;Pasha MS;Hatzold K;Corbett E;Barr-DiChiara M;Rodger AJ;Weatherburn P;Geng E;Baggaley R;Johnson C
通讯作者：
Johnson C