Uptake and impact of facility-based HIV self-testing on PrEP delivery: a pilot study among young women in Kisumu, Kenya
Uptake and impact of facility-based HIV self-testing on PrEP delivery: a pilot study among young women in Kisumu, Kenya
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DOI：
10.1002/jia2.25561
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发表时间：
2020-08-01
影响因子：
6
通讯作者：
Baeten, Jared M.
中科院分区：
文献类型：
--
作者：
Wanga, Valentine;Omollo, Victor;Baeten, Jared M.
简介HIV检测是预防HIV的暴露前预防（PrEP）的必要组成部分。然而，重复测试在忙碌、人员不足的临床环境中可能具有挑战性，这可能会对PrEP的吸收和持续产生负面影响。我们前瞻性地评估了可选的设施为基础的艾滋病毒自我检测（HIVST）在年轻女性中使用PrEP在implementationprograms.MethodsBetween二月和十一月2019年，我们收集了数据，从年轻女性接受PrEP在两个计划生育设施在基苏穆，肯尼亚。在每次PrEP随访中，妇女可以选择提供者发起的检测和HIVST。我们评估了与HIVST吸收和比较满意的HIV检测和临床经验之间的受体和下降的HIVST.ResultsA共172名妇女提供HIVST在202 PrEP后续访问的相关因素。中位年龄为21岁，27%的人有多个伴侣，15%的人报告以前使用过HIVST。在34.7%（70/202）的访视中接受了HIVST。年龄（每年调整的相对风险（aRR）1.09，95%CI（置信区间）1.01至1.18），从未结婚（aRR 1.81，95%CI 1.11至2.95）和有更多的PrEP随访访视（每次访视aRR 1.13，95%CI 1.04至1.23）与HIVST摄取相关。与HIVST下降者相比，HIVST接受者更有可能对他们的整体检测体验感到非常满意（73%对47%的访问，p = 0.003），并且更有可能说他们将来会使用HIVST（96%对76%，p < 0.001）。接受艾滋病毒检测的妇女比选择标准提供者发起的艾滋病毒检测的妇女就诊时间短（中位数[IQR]：33 [32，38] vs. 54 [41.5，81]分钟，p = 0.003）。结论在肯尼亚的这项试点评估中，大约三分之一使用PrEP的妇女选择了HIVST而不是提供者发起的测试，那些选择HIVST的人在诊所花的时间更少，而且对他们的经历总体上很满意。在PrEP交付中使用HIVST是可行的，并且有可能简化PrEP交付并给予客户测试自主权。需要进行更多的研究，以探索PrEP提供中的最佳艾滋病毒复检策略，包括在更大规模和不同环境中使用HIVST。
IntroductionHIV testing is a required part of delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, repeat testing can be challenging in busy, under-staffed clinical settings, which could negatively impact PrEP uptake and continuation. We prospectively evaluated optional facility-based HIV self-testing (HIVST) among young women using PrEP in an implementation programme.MethodsBetween February and November 2019, we collected data from young women receiving PrEP at two family planning facilities in Kisumu, Kenya. At each PrEP follow-up visit, women were given the option to choose between provider-initiated testing and HIVST. We assessed factors associated with HIVST uptake and compared satisfaction with HIV testing and clinic experience between acceptors and decliners of HIVST.ResultsA total of 172 women were offered HIVST at 202 PrEP follow-up visits. The median age was 21 years, 27% had multiple partners and 15% reported previously using HIVST. HIVST was accepted at 34.7% (70/202) of visits. Age (adjusted relative risk (aRR) 1.09 per year, 95% CI (confidence interval) 1.01 to 1.18), never being married (aRR 1.81, 95% CI 1.11 to 2.95) and having more PrEP follow-up visits (aRR 1.13 per visit, 95% CI 1.04 to 1.23) were associated with HIVST uptake. Compared to HIVST decliners, HIVST acceptors were more likely to be very happy with their overall testing experience (73% vs. 47% of visits, p = 0.003) and were more likely to say they would use HIVST in the future (96% vs. 76%, p < 0.001). Women who accepted HIVST had shorter visits than those choosing standard provider-initiated HIV testing (median [IQR]: 33 [32, 38] vs. 54 [41.5, 81] minutes, p = 0.003).ConclusionsIn this pilot evaluation in Kenya, about one-third of women using PrEP opted for HIVST over provider-initiated testing, and those choosing HIVST spent less time in the clinic and were generally satisfied with their experience. HIVST in PrEP delivery is feasible and has the potential to simplify PrEP delivery and give clients testing autonomy. Additional studies are needed to explore optimal HIV retesting strategies in PrEP delivery, including the use of HIVST in PrEP at a larger scale and in different settings.