Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial.
Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial.
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DOI：
10.1371/journal.pmed.1003365
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发表时间：
2020-10
期刊：
影响因子：
15.8
通讯作者：
Li X
中科院分区：
文献类型：
--
作者：
Zhang C;Koniak-Griffin D;Qian HZ;Goldsamt LA;Wang H;Brecht ML;Li X
在中国，男男性行为者（MSM）中艾滋病毒的流行正在迅速增长，但艾滋病毒检测仍然不够理想。我们的目的是确定HIV自我检测（HIV自检）干预对中国MSM及其性伴侣HIV检测频率的影响。这项随机对照试验在中国湖南省的4个城市进行。从社区招募性活跃和艾滋病毒阴性的男男性行为者，并随机分配（1:1）到干预组或对照组。对照组的参与者可以获得基于现场的艾滋病毒检测（shbht）；干预组在入组时免费提供2个基于手指刺痛的艾滋病毒检测试剂盒，除shbht外，每3个月可通过快递收到2至4个试剂盒，为期1年。鼓励他们向性伴侣分发艾滋病毒传播工具包。主要结果是男男性行为者参与者进行艾滋病毒检测的次数，次要结果是其性伴侣在12个月的随访期间进行艾滋病毒检测的次数。主要和次要结局的效应量以干预组和对照组之间测试频率的标准化平均差（SMD）来评估。在2018年4月14日至2018年6月30日期间，招募了230名男同性恋者。平均年龄29岁；77%的人上过大学；75%是单身。完成至少一份随访问卷的分析人群中，干预组110人（93%,110/118），对照组106人（95%,106/112）。干预组每个参与者的平均HIV检测频率（3.75）高于对照组（1.80；SMD为1.26;95% CI 0.97-1.55; P < 0.001）。这一差异主要是由于两组之间的HIVST差异（干预组2.18 vs对照组0.41;SMD 1.30; 95% CI 1.01-1.59; P < 0.001），而shbht的平均频率具有可比性（1.57 vs 1.40, SMD 0.14; 95% CI - 0.13 ~ 0.40; P = 0.519）。每个参与者的性伴侣的HIV检测平均频率在干预组高于对照组（2.65比1.31;SMD 0.64; 95% CI 0.36 - 0.92; P < 0.001），这一差异也是由于两组之间的HIV检测差异（干预组1.41比对照组0.36;SMD 0.75; 95% CI 0.47-1.04; P < 0.001），但与shbht无关（1.24比0.96;SMD 0.23; 95% CI - 0.05至0.50;P = 0.055）。零膨胀泊松回归分析显示，干预组接受HIV检测的可能性是对照组的2.1倍（校正率比[RR] 2.10; 95% CI 1.75-2.53, P < 0.001），其性伴侣接受HIV检测的可能性是对照组的1.55倍（1.55,1.23-1.95,P < 0.001）。在研究期间，干预组3人HIV检测呈阳性，对照组0人，干预组8名性伴侣HIV检测呈阳性。没有其他不良事件的报道。本研究的局限性包括：shbht数量的数据仅基于参与者的自我报告，但干预组的HIVST自我报告数量得到了验证；参与者间接报告了伴侣艾滋病毒检测的次数，因为很难接触到他们的每个伴侣。在本研究中，我们发现提供免费的HIV试剂盒显著提高了中国MSM的检测频率，并通过在他们的性网络中分发试剂盒来加强伴侣的HIV检测，有效地扩大了HIV检测覆盖率。中国临床试验注册中心ChiCTR1800015584。张慈和他的同事研究了中国为男男性行为者提供艾滋病病毒自我检测试剂盒的情况。在中国，男男性行为者（MSM）中艾滋病毒的流行正在迅速增长，但艾滋病毒检测仍然不够理想。在高收入国家，提供艾滋病毒自我检测试剂盒已被证明在促进男男性行为者进行艾滋病毒检测方面是有效的，但在中国等低收入和中等收入国家，这种效果的证据却很缺乏。世卫组织指南提倡通过性网络分发艾滋病毒传播试剂盒进行伴侣艾滋病毒检测；然而，没有确凿的证据表明艾滋病毒传播在改善男男性行为者的PHT方面是有效的。我们探讨了提供免费艾滋病病毒检测试剂盒对中国男男性行为者及其性伴侣艾滋病病毒检测频率的影响。在12个月的研究期间，干预组男男性行为者的HIV检测总频率（平均= 3.75）高于对照组（平均= 1.80）。标准化平均差（SMD）为1.26 （95% CI 0.97-1.55）。干预组中MSM性伴侣的HIV检测总频率高于对照组（2.65比1.31）。SMD为0.64 （95% CI 0.36-0.92）。这项随机对照试验的结果支持在中国等中低收入国家提供免费艾滋病毒检测试剂盒对提高男男性行为者艾滋病毒检测频率的有效性。通过男男性行为者向其性伴侣分发艾滋病病毒包，提供艾滋病病毒治疗包可显著提高PHT。这种有效的干预有可能通过中国男同性恋者的社会和性网络轻松扩大规模。
The HIV epidemic is rapidly growing among men who have sex with men (MSM) in China, yet HIV testing remains suboptimal. We aimed to determine the impact of HIV self-testing (HIVST) interventions on frequency of HIV testing among Chinese MSM and their sexual partners. This randomized controlled trial was conducted in 4 cities in Hunan Province, China. Sexually active and HIV-negative MSM were recruited from communities and randomly assigned (1:1) to intervention or control arms. Participants in the control arm had access to site-based HIV testing (SBHT); those in the intervention arm were provided with 2 free finger-prick-based HIVST kits at enrollment and could receive 2 to 4 kits delivered through express mail every 3 months for 1 year in addition to SBHT. They were encouraged to distribute HIVST kits to their sexual partners. The primary outcome was the number of HIV tests taken by MSM participants, and the secondary outcome was the number of HIV tests taken by their sexual partners during 12 months of follow-up. The effect size for the primary and secondary outcomes was evaluated as the standardized mean difference (SMD) in testing frequency between intervention and control arms. Between April 14, 2018, and June 30, 2018, 230 MSM were recruited. Mean age was 29 years; 77% attended college; 75% were single. The analysis population who completed at least one follow-up questionnaire included 110 (93%, 110/118) in the intervention and 106 (95%, 106/112) in the control arm. The average frequency of HIV tests per participant in the intervention arm (3.75) was higher than that in the control arm (1.80; SMD 1.26; 95% CI 0.97–1.55; P < 0.001). This difference was mainly due to the difference in HIVST between the 2 arms (intervention 2.18 versus control 0.41; SMD 1.30; 95% CI 1.01–1.59; P < 0.001), whereas the average frequency of SBHT was comparable (1.57 versus 1.40, SMD 0.14; 95% CI −0.13 to 0.40; P = 0.519). The average frequency of HIV tests among sexual partners of each participant was higher in intervention than control arm (2.65 versus 1.31; SMD 0.64; 95% CI 0.36–0.92; P < 0.001), and this difference was also due to the difference in HIVST between the 2 arms (intervention 1.41 versus control 0.36; SMD 0.75; 95% CI 0.47–1.04; P < 0.001) but not SBHT (1.24 versus 0.96; SMD 0.23; 95% CI −0.05 to 0.50; P = 0.055). Zero-inflated Poisson regression analyses showed that the likelihood of taking HIV testing among intervention participants were 2.1 times greater than that of control participants (adjusted rate ratio [RR] 2.10; 95% CI 1.75–2.53, P < 0.001), and their sexual partners were 1.55 times more likely to take HIV tests in the intervention arm compared with the control arm (1.55, 1.23–1.95, P < 0.001). During the study period, 3 participants in the intervention arm and none in the control arm tested HIV positive, and 8 sexual partners of intervention arm participants also tested positive. No other adverse events were reported. Limitations in this study included the data on number of SBHT were solely based on self-report by the participants, but self-reported number of HIVST in the intervention arm was validated; the number of partner HIV testing was indirectly reported by participants because of difficulties in accessing each of their partners. In this study, we found that providing free HIVST kits significantly increased testing frequency among Chinese MSM and effectively enlarged HIV testing coverage by enhancing partner HIV testing through distribution of kits within their sexual networks. Chinese Clinical Trial Registry ChiCTR1800015584. Ci Zhang and colleagues study the provision of HIV self-testing kits for men who have sex with men in China. The HIV epidemic is rapidly growing among men who have sex with men (MSM) in China, yet HIV testing remains suboptimal. Provision of HIV self-testing (HIVST) kits has been shown to be effective in promoting HIV testing among MSM in high-income countries, but there is a scarcity of evidence about the effects in low- and middle-income countries such as China. WHO guidelines advocate partner HIV testing (PHT) through sexual network distribution of HIVST kits; however, there is no solid evidence on the effectiveness of HIVST on improving PHT among MSM. We explored the impact of providing free HIVST kits on HIV testing frequency among Chinese MSM and their sexual partners. During the 12-month study period, the total frequency of HIV testing among MSM in the intervention arm (mean = 3.75) was higher than those in the control arm (mean = 1.80). The standardized mean difference (SMD) was 1.26 (95% CI 0.97–1.55). The total frequency of HIV testing among sexual partners of MSM was higher in the intervention than in the control arm (2.65 versus 1.31). The SMD was 0.64 (95% CI 0.36–0.92). Results from this randomized controlled trial support the effectiveness of providing free HIVST kits on improving HIV testing frequency among MSM in a low- and middle-income country such as China. Provision of HIVST kits could significantly enhance PHT through distribution of kits from MSM to their sexual partners. This effective intervention has the potential to be easily scaled up through the social and sexual networks of MSM in China.
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DOI：
10.1016/s2352-3018(16)00041-2
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The lancet. HIV
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