Self-Conducted HIV Tests - Improving HIV Prevention in Key Populations

描述(申请人提供)：艾滋病毒检测可以减少艾滋病毒阳性男男性行为(MSM)中的危险性行为，并提供进入艾滋病毒/艾滋病护理和治疗的门户。然而，南非的男男性接触者目前没有以与他们的风险相称的比率利用基于诊所的艾滋病毒检测，而且知道他们状况的人太少了。在南非，项目在很大程度上未能吸引与男性发生性行为的男性(MSM)：这是一个疾病负担极高、未确诊艾滋病毒感染率极高的人群。该调查小组最近在姆普马兰加省进行的生物行为监测数据显示，男男性接触者的流行率超过30%，54%的艾滋病毒阳性男男性接触者在参与调查之前不知道自己的状况。在南非男男性接触者中扩大艾滋病毒检测的迫切需要的战略可能包括新的艾滋病毒自我检测试剂盒，它提供了一种替代基于诊所的检测的方法。自我检测将检测扩展到诊所之外，这对MSM和其他需要更频繁检测并不太愿意获得诊所服务的关键人群具有特别重要的意义。虽然自行进行的艾滋病毒检测可以扩大南非的检测选择范围，从而促进更早地发现和治疗艾滋病毒，但缺乏关于在非洲男男性接触者中引入艾滋病毒自我检测的可接受性、可行性或潜在行为影响的信息。为了解决这一差距，我们建议确定目前在NIH赞助的队列中登记的南非MSM(R01AI092892，Lane)中艾滋病毒自我检测的可接受性(目标1)、可行性(目标2)和行为影响(目标3)。我们将探索南非男男性接触者是否将使用自我检测；如何、何时、在哪里、何种类型以及与谁一起使用自我检测；如何通过将自我检测试剂盒引入这个社区来改革性危险行为；以及确保在这一服务不足和高风险人群中进行自我检测后与护理相联系的战略。我们会先进行一项先导研究，以探讨血液为基础和以血液为基础的药物的初步接受性，从而达到这些目标。 口腔液体自检，并了解在受控环境中确保两种自检的安全和正确使用所必需的内容。然后我们将进行一项试点研究，我们将向HIV阴性的MSM分发自我检测试剂盒，并在6个月的过程中跟踪他们的使用情况。我们将在参与从高发地区Gert、Sibande和Ehlanzeni地区招募的队列的MSM中实施这项研究。这项提议提供了一个独特的机会，可以在NIH支持的已建立的队列中探索MSM的自我检测，在这些队列中，生产性的研究伙伴关系已经在进行中。拟议的研究将提供至关重要的信息，以了解自我检测如何适用于遇到诊所检测障碍的高危社区的扩展检测选择方案，并支持未来的研究，以确定引入自我检测是否可以改善早期发现和进入护理并促进更安全的性行为，从而导致预防成果。

DESCRIPTION (provided by applicant): HIV testing can decrease risky sexual behavior among HIV-positive men who have sex with men (MSM) and provide a gateway into HIV/AIDS care and treatment. MSM in South Africa, however, do not currently utilize clinic-based HIV testing at a rate commensurate with their risk and too few know their status. In South Africa programs have largely failed to engage Men who have Sex with Men (MSM): a population with an extremely high burden of disease and high rates undiagnosed HIV infections. Recent bio-behavioral surveillance data undertaken by this investigative team in Mpumalanga Province demonstrated prevalence among MSM at above 30%, with 54% of HIV positive MSM unaware of their status prior to survey participation. Urgently needed strategies to expand HIV testing among MSM in South Africa may include new HIV self-testing kits that offer an alternative to clinic-based testing. Self-tests expand testing beyond the clinic, which is of particular significance for MSM and other key populations who require more frequent testing and are less comfortable accessing clinic services. While self-conducted HIV tests could expand the package of testing options in South Africa, thus facilitating earlier HIV detection and treatment, there isa lack of information regarding acceptability, feasibility, or potential behavioral impacts of introducing the HIV self-test among African MSM. To address this gap, we propose to determine the acceptability (Aim 1), the feasibility (Aim 2) and the behavioral impacts (aim 3) of HIV self-testing among South African MSM currently enrolled in NIH-sponsored cohorts (R01AI092892, Lane). We will explore whether self-testing will be used by South African MSM; how, when, where, what kind, and with whom self-tests are utilized; how sexual risk behaviors may be modified by introducing self-test kits into this community; and strategies to ensure linkage to care following self-testing in this underserved and high risk population. We will achieve these aims by first conducting a pre-pilot study to explore initial acceptability of both blood-based and oral fluid self-tests and to understand what is necessary to ensure safe and correct usage of both self-tests in a controlled environment. We will then conduct a pilot study, where we will distribute self-testing kits to HIV-negative MSM and follow their use over the course of 6 months. We will implement this study among MSM participating in cohorts recruited from the high prevalence Gert Sibande and Ehlanzeni districts. This proposal offers a unique opportunity to explore self-testing among MSM within established NIH-supported cohorts where a productive research partnership is already underway. The proposed research will provide information critical to understanding how self-tests would fit into a package of expanded testing options for high risk communities experiencing barriers to clinic-based testing and support future research to determine whether introduction of self-testing can improve early detection and entry to care and facilitate safer sexual behaviors, thus leading to prevention gains.