Secondary distribution of HIV self-tests: an innovative strategy for promoting male partner testing and reducing risk

项目名称 女性性工作者艾滋病毒自我检测的二次分发：促进男性性工作者的创新战略 艾滋病毒检测和降低艾滋病风险。 项目概要/摘要 在可能感染艾滋病毒的人群中更多地进行艾滋病毒检测，对于实现联合国艾滋病规划署的第一个目标至关重要。 "90 - 90 - 90"目标然而，撒哈拉以南非洲大约55%的艾滋病毒感染者仍然不知道 他们的血清状况，男子的认识低于妇女。虽然社区艾滋病毒检测 虽然艾滋病战略在促进普通人群的艾滋病毒检测方面取得了相当大的成功，但仍有必要 创新的艾滋病毒检测策略，可以接触到关键人群和高风险人群，如男性， 女性性工作者的伴侣。还需要采取干预措施，促进夫妇检测，这可能导致 改善性决策，包括更多地使用避孕套和更多地使用抗逆转录病毒疗法， 防止性传播。艾滋病毒自我检测是一种很有前途的方法，有可能大大减少艾滋病毒感染。 以保密和授权用户的方式增加获得测试的机会。数据来自 地球仪在广泛的人群中表现出对自我测试的高度兴趣和可接受性。 虽然艾滋病毒自我检测可以是一个很好的替代那些不从事定期重复检测， 了解最佳分发策略，以促进最难接触到的个人的自测使用。 一项创新战略是艾滋病毒自我检测的"二次分发"， 自我测试可以将其分发给性伴侣或社交网络中的其他人。该项目将评估 肯尼亚女性性工作者自我检测的二次分发是否可以用于满足多种艾滋病毒 预防目标，包括在高危男性中推广艾滋病毒检测， 披露血清状况、夫妻检测和做出更安全的性行为决定。通过促进更安全的性行为 决策，自我检测的二次分发有可能减少女性艾滋病毒感染率 性工作者，这一人群面临着特别高的艾滋病毒感染风险。根据初步数据， 证明女性性工作者可以安全地将口腔自我测试分发给他们的性伴侣， 在自我测试后，我们将进行一项随机对照试验， 女性性工作者被随机分配接受多次自我检测或一张代金券， 艾滋病毒检测。在目标1中，我们将测试女性性工作者自我测试的二次分布是否会导致 更好地识别艾滋病毒感染者和更安全的性行为。在目标2中，我们将深入开展 访谈，以评估研究参与者的经验，分发自我测试，他们的性伴侣。在目标3中， 将决定女性性工作者自我检测的二次分发的成本效益。项目 将有助于确定艾滋病毒自我检测是否有助于促进多个艾滋病毒预防目标。它将 还为自我检测的最佳分配战略提供指导， 制定艾滋病毒自我检测政策，并扩大自我检测的提供。

Project Title Secondary distribution of HIV self-tests by female sex workers: an innovative strategy for promoting male partner testing and reducing HIV risk. Project Summary/Abstract Greater uptake of HIV testing among those likely to be HIV-infected is vital for meeting the first of the UNAIDS “90-90-90” targets. However, roughly 55% of HIV-infected individuals in sub-Saharan Africa remain unaware of their serostatus, with men having lower awareness than women. While community-based HIV testing strategies have had considerable success in promoting HIV testing in the general population, there is a need for innovative HIV testing strategies that can reach key populations and high-risk individuals such as male partners of female sex workers. Interventions are also needed to promote couples testing, which can result in improved sexual decision-making, including increased condom use and increased antiretroviral therapy use to prevent sexual transmission. HIV self-testing is a promising approach that has the potential to substantially increase access to testing in a manner that is confidential and empowering for users. Data from across the globe demonstrate high interest in and acceptability of self-testing among a wide range of populations. Although HIV self-testing can be a good alternative for those not engaged in regular repeat testing, little is known about the optimal distribution strategies for facilitating self-test use by the hardest-to-reach individuals. One innovative strategy is `secondary distribution' of HIV self-tests, whereby an individual who is given multiple self-tests can distribute them to sexual partners or to others in their social network. This project will evaluate whether secondary distribution of self-tests by female sex workers in Kenya can be used to fulfill multiple HIV prevention goals, including the promotion of HIV testing among high-risk men and the facilitation of mutual disclosure of serostatus, couples testing, and safer sexual decision making. By facilitating safer sexual decision-making, secondary distribution of self-tests has the potential to reduce HIV incidence among female sex workers, a population that faces an especially high risk of HIV infection. Building on preliminary data in demonstrating that female sex workers can safely distribute oral self-tests to their sexual partners and make safer sexual behavior decisions following self-testing, we will conduct a randomized controlled trial in which female sex workers are randomized to receive multiple self-tests or a voucher to refer partners to clinic-based HIV testing. In Aim 1, we will test whether secondary distribution of self-tests by female sex workers results in greater identification of HIV-infected men and safer sexual behaviors. In Aim 2, we will conduct in-depth interviews to assess study participants' experiences distributing self-tests to their sexual partners. In Aim 3, we will determine the cost-effectiveness of secondary distribution of self-tests by female sex workers. The project will help determine whether HIV self-testing can be useful in furthering multiple HIV prevention goals. It will also provide guidance on optimal distribution strategies for self-tests as countries in sub-Saharan Africa develop HIV self-testing policies and scale-up the availability of self-tests.