Community-based HIV self-testing: a cluster-randomised trial of supply-side financial incentives and time-trend analysis of linkage to antiretroviral therapy in Zimbabwe.
Community-based HIV self-testing: a cluster-randomised trial of supply-side financial incentives and time-trend analysis of linkage to antiretroviral therapy in Zimbabwe.
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DOI：
10.1136/bmjgh-2020-003866
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发表时间：
2021-07
影响因子：
8.1
通讯作者：
Cowan FM
中科院分区：
文献类型：
--
作者：
Sibanda EL;Neuman M;Tumushime M;Mangenah C;Hatzold K;Watadzaushe C;Mutseta MN;Dirawo J;Napierala S;Ncube G;Terris-Prestholt F;Taegtmeyer M;Johnson C;Fielding KL;Weiss HA;Corbett E;Cowan FM
艾滋病毒自我检测(HIVST)需要与检测后服务相联系，以最大限度地发挥其好处。我们评估了社区HIVST后供应方激励对联系的影响，并评估了基于设施的抗逆转录病毒疗法(ART)启动的时间趋势。2016年8月至2017年8月，津巴布韦38个农村社区的社区分销商在19-25个 日活动中挨家挨户地分发HIVST。社区被分配(1：1)，采用受限随机方法，每个CBD(非激励部门)一次性获得50美元的薪酬，或者每个访问移动外展服务的客户获得50美元加0.20美元的激励(条件激励部门)。6周后由人口调查评估的主要结果是自我报告的对任何临床服务的接受，并用随机效果Logistic回归分析。另外，非随机化的差异差异每月抗逆转录病毒治疗的差异分析了三个时间段(6个 月基线； 运动；3个月后)在公立诊所有(40个诊所)和没有(124个诊所)HIVST分布在集水区。共有445个条件诱因CBD分发了39205个HIVST试剂盒(Mean/CBD：88；95% CI：85至92)；447个非诱因CBD分发了41个 173试剂盒(Mean/CBD：93；95% CI：89至96)。参与调查的人数为7146/8566人(83.4%)，其中3593人(50.3%)报告了自我测试，其中1305人(18.3%)以前没有进行过测试。条件激励组(1062/3698，28.7%)和非激励组(1075/3448，31.2%)患者对门诊服务的利用相似(调整后的危险比(ARR)为0.94，95% CI：0.86~1.03)。然而，新诊断/未接受治疗的HIVST+患者的验证性测试更高(条件激励：25/33，75.8%比非激励：20/40，50.0%：ARR：1.59，95% CI：1.0 5~2.39)。总共发生了12次 808次抗逆转录病毒治疗，在HIVST诊所和非HIVST诊所之间的启动率没有基线或运动后的差异，但在分配期间，HIVST诊所的启动率从每月7.31次增加到9.59次，ARR：1.27，95% CI 1.17到1.39。以社区为基础的HIVST运动获得了很高的测试接受率，暂时与对抗逆转录病毒治疗的需求增加有关。小规模的供应方激励措施没有影响一般的临床使用，但可能增加了对新诊断的HIVST阳性参与者的验证性测试。PACTR201607001701788。
HIV self-testing (HIVST) requires linkage to post-test services to maximise its benefits. We evaluated effect of supply-side incentivisation on linkage following community-based HIVST and evaluated time-trends in facility-based antiretroviral therapy (ART) initiations. From August 2016 to August 2017 community-based distributors (CBDs) in 38 rural Zimbabwean communities distributed HIVST door-to-door in 19–25 day campaigns. Communities were allocated (1:1) using constrained randomisation to either one-off US$50 remuneration per CBD (non-incentive arm), or US$50 plus US$0.20 incentive per client visiting mobile-outreach services (conditional-incentive arm). The primary outcome, assessed by population survey 6 weeks later, was self-reported uptake of any clinic service, analysed with random-effects logistic regression. Separately, non-randomised difference-in-differences in monthly ART initiations were analysed for three time periods (6 months baseline; HIVST campaign; 3 months after) at public clinics with (40 clinics) and without (124 clinics) HIVST distribution in catchment area. A total of 445 conditional-incentive CBDs distributed 39 205 HIVST kits (mean/CBD: 88; 95% CI: 85 to 92) and 447 non-incentive CBDs distributed 41 173 kits (mean/CBD: 93; 95% CI: 89 to 96). Survey participation was 7146/8566 (83.4%), with 3593 (50.3%) reporting self-testing including 1305 (18.3%) previously untested individuals. Use of clinic services post-HIVST was similar in conditional-incentive (1062/3698, 28.7%) and non-incentive (1075/3448, 31.2%) arms (adjusted risk ratio (aRR) 0.94, 95% CI: 0.86 to 1.03). Confirmatory testing by newly diagnosed/untreated HIVST+clients was, however, higher (conditional-incentive: 25/33, 75.8% vs non-incentive: 20/40, 50.0%: aRR: 1.59, 95% CI: 1.05 to 2.39). In total, 12 808 ART initiations occurred, with no baseline or postcampaign differences between initiation rates in HIVST versus non-HIVST clinics, but initiation rates increased from 7.31 to 9.59 initiations per month in HIVST clinics during distribution, aRR: 1.27, 95% CI 1.17 to 1.39. Community-based HIVST campaigns achieved high testing uptake, temporally associated with increased demand for ART. Small supply-side incentives did not affect general clinic usage but may have increased confirmatory testing for newly diagnosed HIVST positive participants. PACTR201607001701788.
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影响因子：
6
作者：
Fuente-Soro L;Lopez-Varela E;Augusto O;Sacoor C;Nhacolo A;Honwana N;Karajeanes E;Vaz P;Naniche D
通讯作者：
Naniche D
影响因子：
16.1
作者：
Cowan, Frances M.;Davey, Calum;Hargreaves, James R.
通讯作者：
Hargreaves, James R.
DOI：
10.1093/infdis/jiv040
发表时间：
2015-08-15
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Cambiano V;Ford D;Mabugu T;Napierala Mavedzenge S;Miners A;Mugurungi O;Nakagawa F;Revill P;Phillips A
通讯作者：
Phillips A
影响因子：
4
作者：
Montgomery, Alan A;Peters, Tim J;Little, Paul
通讯作者：
Little, Paul
影响因子：
4.5
作者：
Krause J;Subklew-Sehume F;Kenyon C;Colebunders R
通讯作者：
Colebunders R