Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study.
Outcomes of a community-led online-based HIV self-testing demonstration among cisgender men who have sex with men and transgender women in the Philippines during the COVID-19 pandemic: a retrospective cohort study.
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DOI：
10.1186/s12889-022-12705-z
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发表时间：
2022-02-21
影响因子：
4.5
通讯作者：
Diones ML
中科院分区：
文献类型：
--
作者：
Eustaquio PC;Figuracion R Jr;Izumi K;Morin MJ;Samaco K;Flores SM;Brink A;Diones ML
菲律宾是全球艾滋病毒流行上升最快的国家，艾滋病毒检测的选择有限，尤其是在新冠肺炎大流行期间，顺性男男性行为者(顺-MSM)和变性人女性(TGW)的艾滋病毒感染率仍然很低。由于艾滋病毒自我检测(HIVST)和基于技术的方法可以协同作用，扩大对艾滋病毒检测的接受，我们的目标是评估社区主导的在线HIVST示范的结果，并探索与HIVST相关的行为和结果相关的因素。我们对参与HIVST演示的顺式男男性接触者和TGW进行了二次数据分析，他们是在网上招募的，并于2020年3月至11月在菲律宾西维萨亚斯进行了设施外测试。我们回顾了人口统计学、性取向和背景相关变量的数据。使用多变量Logistic回归，我们测试了上述协变量和两个主要结果之间的关联，即选择直接辅助HIVST(DAH)和二次分发试剂盒的意愿。HIVST试剂盒分发给647人(590名顺式MSM，57名TGW)，54.6%是首次测试者，10.4%选择DAH，46.1%愿意分发给同龄人。报告率高(99.3%)，反应率为7.6%。虽然预防(100%)和护理(85.7%)的关联性很高，但暴露前预防(0.3%)和抗逆转录病毒治疗(ART)(51.0%)的启动受到限制。目前还没有不良反应的报道。那些有工作、最近有过肛交、选择DAH、不愿意二次分发、在最低限度或没有隔离限制期间获得HIVST的人的反应率显著较高。在过去一年中有三个或更多伴侣的人(AOR = 2.01[CI = 1.01-4.35])和那些在最高隔离限制期间访问的人(AOR = 4.25[CI = 2.46-7.43])选择DAH的可能性更高。愿意分享的几率在城市地区的人中较高(AOR = 1.64[CI = 1.15-2.36])，但在首次测试的人中较低(AOR = 0.45[CI = 0.32-0.62])。HIVST可以有效地接触到难以接触到的人群。虽然在获取基于在线的无辅助方法方面有需求，但仍应提供DAH。应通过将这些服务下放给以社区为基础的组织来提高对PrEP和当天ART的接受程度。在关键人群所处的动态地理和社会文化背景下，差异化服务提供是回应他们的偏好和价值观的关键。
The Philippines, which has the fastest rising HIV epidemic globally, has limited options for HIV testing and its uptake remains low among cisgender men who have sex with men (cis-MSM) and transgender women (TGW), especially amid the COVID-19 pandemic. As HIV self-testing (HIVST) and technology-based approaches could synergize to expand uptake of HIV testing, we aimed to evaluate the outcomes of a community-led online-based HIVST demonstration and to explore factors associated with HIVST-related behaviours and outcomes. We did a secondary data analysis among cis-MSM and TGW who participated in the HIVST demonstration, who were recruited online and tested out-of-facility, in Western Visayas, Philippines, from March to November 2020. We reviewed data on demographics, sexuality-, and context-related variables. Using multivariable logistic regression, we tested for associations between the aforementioned covariates and two primary outcomes, opting for directly-assisted HIVST (DAH) and willingness to secondarily distribute kits. HIVST kits were distributed to 647 individuals (590 cis-MSM, 57 TGW), 54.6% were first-time testers, 10.4% opted DAH, and 46.1% were willing to distribute to peers. Reporting rate was high (99.3%) with 7.6% reactivity rate. While linkage to prevention (100%) and care (85.7%) were high, pre-exposure prophylaxis (PrEP) (0.3%) and antiretroviral therapy (ART) (51.0%) initiation were limited. There were no reports of adverse events. Those who were employed, had recent anal intercourse, opted for DAH, not willing to secondarily distribute, and accessed HIVST during minimal to no quarantine restriction had significantly higher reactivity rates. Likelihood of opting for DAH was higher among those who had three or more partners in the past year (aOR = 2.01 [CI = 1.01–4.35]) and those who accessed during maximal quarantine restrictions (aOR = 4.25 [CI = 2.46–7.43]). Odds of willingness to share were higher among those in urban areas (aOR = 1.64 [CI = 1.15–2.36]) but lower among first-time testers (aOR = 0.45 [CI = 0.32–0.62]). HIVST could effectively reach hard-to-reach populations. While there was demand in accessing online-based unassisted approaches, DAH should still be offered. Uptake of PrEP and same-day ART should be upscaled by decentralizing these services to community-based organizations. Differentiated service delivery is key to respond to preferences and values of key populations amid the dynamic geographical and sociocultural contexts they are in.
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