Effect of Internet-Distributed HIV Self-tests on HIV Diagnosis and Behavioral Outcomes in Men Who Have Sex With Men A Randomized Clinical Trial
Effect of Internet-Distributed HIV Self-tests on HIV Diagnosis and Behavioral Outcomes in Men Who Have Sex With Men A Randomized Clinical Trial
复制标题
网络分布式HIV自检对男男性行为者HIV诊断和行为结局的影响：一项随机临床试验
DOI：
10.1001/jamainternmed.2019.5222
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发表时间：
2020-01-01
影响因子：
39
通讯作者：
Wesolowski, Laura
中科院分区：
文献类型：
--
作者：
MacGowan, Robin J.;Chavez, Pollyanna R.;Wesolowski, Laura
向互联网招募的男男性行为者提供艾滋病毒自我检测是否会在12个月内增加艾滋病毒检测和感染诊断？在这项随机临床试验中，2665名美国参与者被随机分为2组，与对照组参与者相比，在试验期间，更多的参与者在邮寄HIV自我检测的手臂上报告了3次或更多次的HIV检测，在前3个月，自测组中发现了12例感染，而对照组中发现了2例感染。测试报告了他们的社交网络成员中的34例感染。意义提供免费的HIV自我检测有助于提高参与者及其社交网络成员的感染意识。这项随机临床试验评估了提供HIV自我检测对男男性行为者的检测频率、HIV感染诊断和性风险行为的影响。重要性未确诊的HIV感染导致治疗延迟和传播增加。艾滋病毒自我检测可以提高男男性行为者（MSM）对感染的认识。目的评价提供艾滋病病毒（HIV）自我检测对检测频率、HIV感染诊断和危险性行为的影响。设计、设置和参与者这项为期12个月的纵向、2组随机临床试验从2015年3月至8月通过在线横幅广告招募MSM。被招募的人至少年满18岁，报告在过去一年中与男性发生过肛交，从未检测出艾滋病毒呈阳性，并且是有邮寄地址的美国居民。参与者完成了季度在线调查。电话记录和实验室检查结果纳入分析中，该分析于2017年8月至2018年12月完成。干预措施所有参与者都可以访问基于网络的在线HIV检测资源和电话咨询。参与者以1：1的比例随机分配到对照组或自测（ST）组，在完成基线调查后接受4次艾滋病毒自测，并可选择在完成季度调查后补充自测。研究完成时，向所有参与者提供2次自测和1个干血斑采集试剂盒。主要结果和测量主要结果是HIV检测频率（在试验期间检测≥ 3次）和使用研究HIV自测的两组参与者和社交网络成员中新发现的HIV感染人数。次要结局包括性行为（例如，肛交、血清分选）。结果在2665名参与者中，平均（SD）年龄为30（9.6）岁，1540（57.8%）人为白色，443（16.6%）人在入组前从未进行过HIV检测。每个时间点的保留率均超过54%，1991名（74.7%）参与者启动了1次或多次随访调查。在试验期间，ST参与者报告测试3次或以上的人数多于对照参与者（777/1014 [76.6%] vs 215/977 [22.0%]; P <0.01）。试验期间新发现的感染的累积数量在ST参与者中是对照参与者的两倍（25/1325 [1.9%] vs 11/1340 [0.8%]; P = 0.02），前3个月发现的HIV感染差异最大（12/1325 [0.9%] vs 2/1340 [0.1%]; P <0.01）。ST参与者报告了使用自测的社交网络成员中新发现的34例感染。结论和相关性分发艾滋病毒自我检测提供了一个有价值的机制，以提高艾滋病毒感染的认识和预防传播的男男性行为者。
Question Does provision of HIV self-tests to internet-recruited men who have sex with men increase HIV testing and diagnosis of infection over a 12-month period? Findings In this randomized clinical trial of 2665 US participants randomized to 2 groups, more participants in the arm that was mailed HIV self-tests reported testing for HIV 3 or more times during the trial compared with control participants, with 12 infections identified in the self-testing arm in the first 3 months compared with 2 infections in the control arm. Participants who shared the study self-tests reported 34 infections among their social network members. Meaning Providing free HIV self-tests helped increase awareness of infection among participants and their social network members.This randomized clinical trial evaluates the effect of providing HIV self-tests on frequency of testing, diagnoses of HIV infection, and sexual risk behaviors among men who have sex with men.Importance Undiagnosed HIV infection results in delayed access to treatment and increased transmission. Self-tests for HIV may increase awareness of infection among men who have sex with men (MSM). Objective To evaluate the effect of providing HIV self-tests on frequency of testing, diagnoses of HIV infection, and sexual risk behaviors. Design, Setting, and Participants This 12-month longitudinal, 2-group randomized clinical trial recruited MSM through online banner advertisements from March through August 2015. Those recruited were at least 18 years of age, reported engaging in anal sex with men in the past year, never tested positive for HIV, and were US residents with mailing addresses. Participants completed quarterly online surveys. Telephone call notes and laboratory test results were included in the analysis, which was completed from August 2017 through December 2018. Interventions All participants had access to online web-based HIV testing resources and telephone counseling on request. Participants were randomized in a 1:1 ratio to the control group or a self-testing (ST) group, which received 4 HIV self-tests after completing the baseline survey with the option to replenish self-tests after completing quarterly surveys. At study completion, all participants were offered 2 self-tests and 1 dried blood spot collection kit. Main Outcomes and Measures Primary outcomes were HIV testing frequency (tested >= 3 times during the trial) and number of newly identified HIV infections among participants in both groups and social network members who used the study HIV self-tests. Secondary outcomes included sex behaviors (eg, anal sex, serosorting). Results Of 2665 participants, the mean (SD) age was 30 (9.6) years, 1540 (57.8%) were white, and 443 (16.6%) had never tested for HIV before enrollment. Retention rates at each time point were more than 54%, and 1991 (74.7%) participants initiated 1 or more follow-up surveys. More ST participants reported testing 3 or more times during the trial than control participants (777 of 1014 [76.6%] vs 215 of 977 [22.0%]; P < .01). The cumulative number of newly identified infections during the trial was twice as high in the ST participants as the control participants (25 of 1325 [1.9%] vs 11 of 1340 [0.8%]; P = .02), with the largest difference in HIV infections identified in the first 3 months (12 of 1325 [0.9%] vs 2 of 1340 [0.1%]; P < .01). The ST participants reported 34 newly identified infections among social network members who used the self-tests. Conclusions and Relevance Distribution of HIV self-tests provides a worthwhile mechanism to increase awareness of HIV infection and prevent transmission among MSM.