Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial.
Promoting Partner Testing and Couples Testing through Secondary Distribution of HIV Self-Tests: A Randomized Clinical Trial.
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DOI：
10.1371/journal.pmed.1002166
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发表时间：
2016-11
期刊：
影响因子：
15.8
通讯作者：
Thirumurthy H
中科院分区：
文献类型：
--
作者：
Masters SH;Agot K;Obonyo B;Napierala Mavedzenge S;Maman S;Thirumurthy H
提高撒哈拉以南非洲孕妇和产后妇女的伴侣艾滋病毒检测率和夫妇检测率，对于成功开展艾滋病毒综合预防，包括预防母婴传播至关重要。我们的目的是确定是否提供多个艾滋病毒自我检测孕妇和产后妇女的二次分布是更有效地促进合作伙伴的测试和夫妇测试比传统的策略，邀请诊所为基础的测试。我们于2015年6月11日至2016年1月15日在肯尼亚的基苏穆进行了一项随机试验。将600名年龄在18-39岁的产前和产后妇女随机分为艾滋病毒自我检测（HIVST）组或对照组。HIVST组的参与者获得了两个基于口服液的艾滋病毒检测试剂盒，并指导如何使用它们，并鼓励他们将检测试剂盒分发给他们的男性伴侣或作为夫妇使用两个试剂盒进行检测。对照组的参与者获得了一张诊所艾滋病毒检测的邀请卡，并鼓励他们将卡片分发给他们的男性伴侣，这是许多卫生诊所的常规做法。主要结局是入组后3个月内的伴侣检测。在分析的570名参与者中，HIVST组（90.8%，258/284）比对照组（51.7%，148/286;差异= 39.1%，95%CI 32.4%至45.8%，p < 0.001）更有可能进行伴侣HIV检测。与对照组相比，HIVST组的夫妇测试也更有可能（75.4% vs 33.2%，差异= 42.1%，95%CI 34.7%至49.6%，p < 0.001）。没有参与者报告因艾滋病毒检测而遭受亲密伴侣暴力。这项研究受到自我报告结果的限制，这是许多涉及HIVST的研究中的一个常见限制，因为自我测试的使用方式是私人的。向寻求产前和产后护理的妇女提供多种艾滋病毒自我检测，成功地促进了伴侣检测和夫妻检测。在各国制定艾滋病毒/艾滋病防治政策和寻求新的途径提高男子对艾滋病毒状况的认识和促进夫妇检测时，这种做法值得进一步考虑。ClinicalTrials.gov NCT02386215。在一项随机临床试验中，Harsha Thirumurthy及其同事比较了向孕妇和产后妇女提供艾滋病毒自我检测的有效性，以及使用邀请进行基于诊所的检测的传统策略。尽管近年来取得了进展，但在撒哈拉以南非洲，男子的艾滋病毒检测率低于妇女，将近一半的艾滋病毒抗体阳性者仍然不知道自己的艾滋病毒状况;这是实现艾滋病规划署消除艾滋病毒的90-90-90目标的一个主要障碍。在孕妇和产后妇女中，为了预防艾滋病毒，鼓励男性伴侣进行检测，但在许多国家仍然不常见。世卫组织最近关于艾滋病毒检测服务的指导方针承认艾滋病毒自我检测作为一种手段的潜力，可以提高其他检测服务无法覆盖的人群的检测率，并呼吁开展更多的研究，以探讨自我检测的潜在益处。由前往保健设施的妇女“二次分发”自我检测结果，有可能增加其男性性伴侣接受检测的机会，并促进结果披露和更安全的性行为决策。我们在肯尼亚西部参加产前和产后诊所的600名妇女中进行了一项随机试验，以确定为她们提供多次艾滋病毒自我检测是否比基于合作伙伴邀请诊所检测的传统策略更有效地促进合作伙伴检测和夫妇检测。在三个月的随访中，据报告，艾滋病毒自我检测组中90%的妇女进行了男性伴侣检测，而对照组中只有52%的妇女进行了检测，这一差异具有统计学意义。在接受多次艾滋病毒自我检测的妇女中，夫妇检测的可能性是接受伴侣邀请的妇女的两倍多（艾滋病毒自我检测组为75%，对照组为33%）。自我检测干预措施是安全和有效的，可促进其伴侣在过去12个月内未进行检测的妇女进行伴侣艾滋病毒检测。这项研究令人鼓舞的结果表明，随着各国制定艾滋病毒自我检测政策，并寻求新的方法来促进男性伴侣检测和夫妇检测，自我检测的二次传播值得进一步考虑。建议进行更多的研究，以探讨在自我检测艾滋病毒阳性的伴侣中进行基于诊所的确证性检测的情况，这超出了本研究的范围。应探讨在其他人群和环境中二次分发战略的可行性，沿着探讨艾滋病毒自我检测促进更安全性行为的潜力。
Achieving higher rates of partner HIV testing and couples testing among pregnant and postpartum women in sub-Saharan Africa is essential for the success of combination HIV prevention, including the prevention of mother-to-child transmission. We aimed to determine whether providing multiple HIV self-tests to pregnant and postpartum women for secondary distribution is more effective at promoting partner testing and couples testing than conventional strategies based on invitations to clinic-based testing. We conducted a randomized trial in Kisumu, Kenya, between June 11, 2015, and January 15, 2016. Six hundred antenatal and postpartum women aged 18–39 y were randomized to an HIV self-testing (HIVST) group or a comparison group. Participants in the HIVST group were given two oral-fluid-based HIV test kits, instructed on how to use them, and encouraged to distribute a test kit to their male partner or use both kits for testing as a couple. Participants in the comparison group were given an invitation card for clinic-based HIV testing and encouraged to distribute the card to their male partner, a routine practice in many health clinics. The primary outcome was partner testing within 3 mo of enrollment. Among 570 participants analyzed, partner HIV testing was more likely in the HIVST group (90.8%, 258/284) than the comparison group (51.7%, 148/286; difference = 39.1%, 95% CI 32.4% to 45.8%, p < 0.001). Couples testing was also more likely in the HIVST group than the comparison group (75.4% versus 33.2%, difference = 42.1%, 95% CI 34.7% to 49.6%, p < 0.001). No participants reported intimate partner violence due to HIV testing. This study was limited by self-reported outcomes, a common limitation in many studies involving HIVST due to the private manner in which self-tests are meant to be used. Provision of multiple HIV self-tests to women seeking antenatal and postpartum care was successful in promoting partner testing and couples testing. This approach warrants further consideration as countries develop HIVST policies and seek new ways to increase awareness of HIV status among men and promote couples testing. ClinicalTrials.gov NCT02386215. In a randomized clinical trial, Harsha Thirumurthy and colleagues compare the efficacy of providing HIV self-tests to pregnant and postpartum women to conventional strategies using invitations to clinic-based testing. Despite progress in recent years, men in sub-Saharan Africa have lower HIV testing rates than women, and nearly half of all HIV-positive individuals remain unaware of their HIV status; this represents a key barrier to meeting the UNAIDS 90-90-90 targets for HIV elimination. Among pregnant and postpartum women, male partner testing has been encouraged for HIV prevention purposes but remains uncommon in many countries. Recent WHO guidelines on HIV testing services have acknowledged the potential of HIV self-testing as a means to increase testing uptake among those not reached by other testing services, and have called for additional research to explore the potential benefits of self-testing. “Secondary distribution” of self-tests by women visiting health facilities has the potential to increase access to testing among their male sexual partners and to promote results disclosure and safer sexual decision-making. We conducted a randomized trial among 600 women attending antenatal and postpartum clinics in western Kenya to determine whether providing them multiple HIV self-tests is more effective at promoting partner testing and couples testing than a conventional strategy based on partner invitations to clinic-based testing. In the three months of follow-up, male partner testing was reported to have occurred for 90% of women in the HIV self-testing group but only 52% of women in the comparison group, a difference that was statistically significant. Couples testing was more than twice as likely among women who received multiple HIV self-tests than women who received invitations for their partners (75% in the HIV self-testing group versus 33% in the comparison group). The self-testing intervention was safe and effective at promoting partner HIV testing among women whose partners had not tested in the past 12 months. The promising results of this study suggest that secondary distribution of self-tests warrants further consideration as countries develop HIV self-testing policies and seek new ways to promote male partner testing and couples testing. Additional research is recommended to explore uptake of clinic-based confirmatory testing among partners who self-test HIV-positive, which was beyond the scope of this research. The feasibility of secondary distribution strategies among other populations and settings should be explored, along with the potential of HIV self-tests to facilitate safer sexual behaviors.
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影响因子：
4.4
作者：
Carballo-Dieguez, Alex;Frasca, Timothy;Balan, Ivan;Ibitoye, Mobolaji;Dolezal, Curtis
通讯作者：
Dolezal, Curtis
DOI：
10.1080/09540121.2013.793269
发表时间：
2013-05-07
影响因子：
1.7
作者：
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通讯作者：
Lo, Ying-Ru
DOI：
10.1016/s2352-3018(15)00182-4
发表时间：
2015-11
期刊：
The lancet. HIV
影响因子：
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作者：
Rosenberg NE;Mtande TK;Saidi F;Stanley C;Jere E;Paile L;Kumwenda K;Mofolo I;Ng'ambi W;Miller WC;Hoffman I;Hosseinipour M
通讯作者：
Hosseinipour M
DOI：
10.1080/09540120701687059
发表时间：
2008-01-01
影响因子：
1.7
作者：
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通讯作者：
Stray-Pedersen, B.
影响因子：
3.8
作者：
Allen, S;Meinzen-Derr, L;Haworth, A
通讯作者：
Haworth, A