Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study.
Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study.
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DOI：
10.1016/s2352-3018(16)00041-2
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发表时间：
2016-06
期刊：
影响因子：
--
通讯作者：
Agot K
中科院分区：
文献类型：
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作者：
Thirumurthy H;Masters SH;Mavedzenge SN;Maman S;Omanga E;Agot K
确定干预措施，增加撒哈拉以南非洲男子接受艾滋病毒检测的机会，对于艾滋病毒综合预防的成功至关重要。艾滋病毒自我检测是一种新出现的方法，具有很高的可接受性，但关于分发自我检测的最佳战略的证据有限。我们探索了一种新的方法，为艾滋病毒感染高风险的妇女提供多种自我检测，以促进伴侣艾滋病毒检测，促进更安全的性决策。在肯尼亚基苏穆的两个地点招募了18-39岁未感染艾滋病毒的妇女：一个设有产前（ANC）和产后（PPC）诊所的卫生机构和一个女性性工作者（FSW）救助中心。在获得知情同意并获得使用OraQuick Rapid HIV 1/2 Test的说明后，在医疗机构和救助中心登记的指数参与者（IP）分别接受了3次和5次自我检测。在入组时和3个月后与IP进行结构化访谈，以确定如何使用自测。主要结果包括IP分发的自测数量，其性伴侣使用自测的IP比例，夫妻测试和自测后的性行为。2015年1月14日至2015年3月13日期间，入组了280例IP（61例ANC、117例PPC、102例FSW）。对265名执行伙伴（96%）进行了后续访谈。大多数有主要性伴侣的IP向该伴侣分发了自测（53/58，91% ANC; 91/106，86% PPC; 64/85，75% FSW）。绝大多数家庭社会工作者也向商业性服务客户分发了至少1份自测报告（82/101，81%）。在分发给IP的主要性伴侣并由其使用的自我测试中，夫妇测试频繁发生（27/53，51% ANC; 62/91，68% PPC;和53/64; 83% FSW）。在分发给IP的性伴侣并由其使用的自我检测中，ANC、PPC和FSW参与者组中分别有3.8%（2/53）、2.2%（2/91）和13.8%（41/298）的检测结果为HIV阳性。与HIV阴性的性伴侣相比，HIV阳性的性伴侣发生性行为的可能性明显降低（18%对62%，p<0.0001），而使用安全套的可能性明显增加（100%对44%，p=0.0018）。在有后续数据的265个实施伙伴中，有4个在分发自测报告时报告了亲密伴侣暴力行为。未报告其他不良事件。向艾滋病毒感染高风险妇女提供多种艾滋病毒自我检测，成功地促进了其性伴侣的艾滋病毒检测，并促进了更安全的性行为决定。随着各国制定自我检测政策和计划，这一新策略值得进一步考虑。
Identifying interventions to increase men’s uptake of HIV testing in sub-Saharan Africa is essential for the success of combination HIV prevention. HIV self-testing is an emerging approach with high acceptability, but limited evidence exists on optimal strategies for distributing self-tests. We explored a novel approach of providing multiple self-tests to women at high risk of HIV acquisition in order to promote partner HIV testing and facilitate safer sexual decision-making. HIV-uninfected women aged 18–39 years were recruited at two sites in Kisumu, Kenya: a health facility with antenatal (ANC) and postpartum (PPC) clinics, and a drop-in center for female sex workers (FSW). Following informed consent and instructions on using the OraQuick Rapid HIV 1/2 Test, index participants (IPs) enrolled at the health facility and drop-in center received 3 and 5 self-tests, respectively. Structured interviews were conducted with IPs at enrollment and over 3 months to determine how self-tests were used. Key outcomes included the number of self-tests distributed by IPs, the proportion of IPs whose sexual partners used a self-test, couples testing, and sexual behavior following self-testing. Between January 14, 2015 and March 13, 2015, 280 IPs were enrolled (61 ANC, 117 PPC, 102 FSW). Follow-up interviews were completed with 265 IPs (96%). Most IPs with a primary sexual partner distributed a self-test to that partner (53/58, 91% ANC; 91/106, 86% PPC; 64/85, 75% FSW). A vast majority of FSW IPs also distributed ≥1 self-tests to commercial sex clients (82/101, 81%). Among self-tests distributed to and used by IPs’ primary sexual partners, couples testing occurred frequently (27/53, 51% ANC; 62/91, 68% PPC; and 53/64; 83% FSW). Among self-tests distributed to and used by IPs’ sexual partners, an HIV-positive result was obtained for 3.8% (2/53), 2.2% (2/91), and 13.8% (41/298) of the tests in the ANC, PPC, and FSW participant groups, respectively. Sexual intercourse was significantly less likely after a sexual partner tested HIV-positive versus HIV-negative (18% vs. 62%, p<0.0001), while condom use was significantly more likely (100% vs. 44%, p=0.0018). Of 265 IPs with follow-up data, four reported intimate partner violence as a result of self-test distribution. No other adverse events were reported. Provision of multiple HIV self-tests to women at high risk of HIV infection was successful in promoting HIV testing among their sexual partners and in facilitating safer sexual decisions. This novel strategy warrants further consideration as countries develop self-testing policies and programs.