From conventional to disruptive: upturning the HIV testing status quo among men who have sex with men in Vietnam
From conventional to disruptive: upturning the HIV testing status quo among men who have sex with men in Vietnam
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DOI：
10.1002/jia2.25127
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发表时间：
2018-07-01
影响因子：
6
通讯作者：
Ha, Giang T. T.
中科院分区：
文献类型：
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作者：
Green, Kimberly E.;Vu, Bao N.;Ha, Giang T. T.
简介越南男男性行为者(MSM)的艾滋病毒流行率正在上升，而每年的艾滋病毒检测接受率一直保持在较低水平，对实现90-90-90的目标构成了重大挑战。男男性行为者寻求艾滋病毒检测的障碍包括对保密性的担忧和缺乏方便的检测选择。两个新的HIV检测策略-HIV Lay提供者和HIV自检(HIVST)在密集的社交媒体推广的同时被试行，以增加不积极从事服务的MSM获得和接受HIV检测的机会和接受。方法作为越南重点人群更大规模HIV Lay和自我检测研究的一部分，我们测量了首次MSM HIV检测人员选择HIV Lay或自我检测的比例以及与首次检测相关的因素。我们还评估了MSM对HIV层间或自我检测以及测试地点和提供者偏好的满意度。结果57.9%(n=320)和51.3%(n=412)的男男性接触者为首次检测。在最终调整的模型中，年轻、收入水平较低、从未用性交易换取金钱的男男性接触者首次检测艾滋病毒和选择进行艾滋病毒层析检测的几率较高；对于HIVST，受教育程度较低的男男性接触者首次检测艾滋病毒的几率较高。在关键人群中，艾滋病毒水平和自我检测导致发现新的艾滋病毒病例(6.8%)高于传统的艾滋病毒检测(2016年估计为1.6%)，而通过社交媒体干预进行检测的男男性接触者的艾滋病毒阳性率更高(11%)。总共确诊了1655例HIV病例，超过90%的人登记了ART服务。结论我们的研究结果表明，通过在线或面对面的互动促进男男性接触者提供的HIV检测和自我检测，为越南的MSM HIV检测服务提供了重要的补充，并可以通过在难以接触和高风险的MSM中增加HIV检测，有效地将他们纳入ART，减少继续传播，从而显著地促进疫情的控制。
Introduction HIV prevalence among men who have sex with men (MSM) in Vietnam is increasing, while annual HIV testing uptake has remained consistently low, posing a significant challenge to reaching the 90-90-90 goals. Barriers to MSM seeking HIV testing include concerns regarding confidentiality and lack of convenient testing options. Two new HIV testing strategies -HIV lay provider and HIV self-testing (HIVST)were piloted alongside intensive social media outreach to increase access to and uptake of HIV testing among MSM not actively engaged in services.Methods We measured the proportion of first-time MSM HIV testers opting for HIV lay or self-testing, and factors that were associated with first-time testing, as part of a larger HIV lay and self-testing study among key populations in Vietnam. We also assessed MSM satisfaction with HIV lay or self-testing, and testing location and provider preferences. Finally, we calculated linkage to care cascade among MSM that were diagnosed and enrolled in anti-retroviral therapy (ART) services.Results Among MSM that sought HIV lay and self-testing, 57.9% (n=320) and 51.3% (n=412) were first-time testers respectively. In the final adjusted models, the odds of being a first-time tester and opting for HIV lay testing were higher among MSM who were young, had lower levels of income and had never exchanged sex for money; for HIVST, the odds of being a first-time HIV tester were higher among MSM that had attained lower levels of education. HIV lay and self-testing resulted in higher detection of new HIV cases (6.8%) compared to conventional HIV testing among key populations (estimated at 1.6% in 2016), while MSM linked to testing through social media interventions presented with even higher HIV-positivity (11%). Combined, 1655 HIV cases were diagnosed and more than 90% were registered for ART services.Conclusions Our findings suggest that MSM-delivered HIV testing and self-testing, promoted through online or face-to-face interactions, offer important additions to MSM HIV testing services in Vietnam, and could significantly contribute to epidemic control by increasing HIV testing among harder-to-reach and higher-risk MSM, effectively enrolling them in ART, and reducing onward transmission.