"If it is left, it becomes easy for me to get tested": Use of oral self-tests and community health workers to maximize the potential of home-based HIV testing among adolescents in Lesotho
"If it is left, it becomes easy for me to get tested": Use of oral self-tests and community health workers to maximize the potential of home-based HIV testing among adolescents in Lesotho
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DOI：
10.1002/jia2.25563
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发表时间：
2020-09-01
影响因子：
6
通讯作者：
Labhardt, Niklaus D.
中科院分区：
文献类型：
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作者：
Amstutz, Alain;Kopo, Mathebe;Labhardt, Niklaus D.
家庭艾滋病毒检测未能在青少年和年轻人中达到高覆盖率，主要是因为他们在家庭检测期间经常缺席。ADORE （ADolescent ORal tEsting，青少年口腔检测）是一项在莱索托农村地区青少年中开展的混合方法嵌套研究，旨在测量以家庭为基础的二次分发艾滋病毒口腔自检（HIVST）对覆盖率的影响，并探讨青少年对这种艾滋病毒自检模式的看法。方法采用聚类随机试验。在干预村群中，对在检测运动中缺席或拒绝检测的家庭成员进行了口腔艾滋病毒检测。在场的一名家庭成员接受了使用艾滋病毒传播技术的培训。村卫生工作者（VHW）对分布的艾滋病毒感染者进行了随访。在对照组中，没有自检。定量结果是120天内AYA（12至24岁）的检测覆盖率，定义为确认HIV检测结果或已知状态，对意向治疗人群使用调整后的随机效应logistic回归。定性地，我们对使用和不使用分布式hiv病毒检测的AYA进行了深入访谈。结果2018年7月至2018年12月，分别纳入49个和57个村，分别有1471户和1620户同意参与调查，1236户和1445户自愿参与调查。家访当天，对照组和干预组的检测覆盖率分别为37%（461/1236）和41%（596/1445）。在120天的随访期间，对照组和干预组中分别有23名和490名AYA了解自己的状况。这导致对照组的检测覆盖率为484/1236(39%)，干预组为1086/1445 (75%)（aOR为8.80 [95% CI 5.81至13.32];p < 0.001）。共进行了21次访谈。二次分配后的个人援助成为一个关键主题，而且外籍家庭佣工通常被视为值得信赖的骨干。结论：在莱索托，在家庭检测期间，由于AYA缺席或拒绝检测，hiv的二次分布导致覆盖率绝对增加了36%。然而，分发应该伴随着关于使用艾滋病毒传播技术的明确说明，并有可能轻松获得更多的个人支持。
Introduction Home-based HIV testing fails to reach high coverage among adolescents and young adults (AYA), mainly because they are often absent during the day of home-based testing. ADORE (ADolescent ORal tEsting) is a mixed-method nested study among AYA in rural Lesotho, measuring the effect of home-based secondary distribution of oral HIV self-tests (HIVST) on coverage, as well as exploring how AYA perceive this HIV self-testing model. Methods ADORE study was nested in a cluster-randomized trial. In intervention village-clusters, oral HIVST were left for household members who were absent or declined testing during a testing campaign. One present household member was trained on HIVST use. Distributed HIVST were followed up by village health workers (VHW). In control clusters no self-tests were distributed. The quantitative outcome was testing coverage among AYA (age 12 to 24) within 120 days, defined as a confirmed HIV test result or known status, using adjusted random-effects logistic regression on the intention-to-treat population. Qualitatively, we conducted in-depth interviews among both AYA who used and did not use the distributed HIVST. Results From July 2018 to December 2018, 49 and 57 villages with 1471 and 1620 consenting households and 1236 and 1445 AYA in the control and intervention arm, respectively, were enrolled. On the day of the home-visit, a testing coverage of 37% (461/1236) and 41% (596/1445) in the control and the intervention arm, respectively, were achieved. During the 120 days follow-up period, an additional 23 and 490 AYA in control and intervention clusters, respectively, knew their status. This resulted in a testing coverage of 484/1236 (39%) in the control versus 1086/1445 (75%) in the intervention arm (aOR 8.80 [95% CI 5.81 to 13.32];p < 0.001). 21 interviews were performed. Personal assistance after the secondary distribution emerged as a key theme and VHWs were generally seen as a trusted cadre. Conclusions Secondary distribution of HIVST for AYA absent or refusing to test during home-based testing in Lesotho resulted in an absolute 36% increase in coverage. Distribution should, however, go along with clear instructions on the use of the HIVST and a possibility to easily access more personal support.