Syphilis self-testing to expand test uptake among men who have sex with men (SST)

在各种资源有限的环境中，梅毒感染导致大量发病。梅毒增加了获得和传播艾滋病毒感染的风险，但通常没有症状。许多具有高风险性行为的男男性行为者（MSM）无法接受梅毒检测，因为集中的检测场所和与检测场所相关的耻辱。一种方法，以增加梅毒测试之间的男同性恋吸收是梅毒自我检测。系统自检让用户使用测试工具包并解释自己的测试结果。艾滋病毒自我检测项目已经向男男性行为者介绍了自我检测的概念，并建立了一个基础设施来分发和衡量自我检测的吸收情况。敏感和特异的梅毒自我检测试剂盒可用于检测梅毒感染，类似于临床实践中常用的梅毒血清学。自我测试可以分散测试，减少与测试相关的耻辱。我们的全国性研究发现，174/699（24.9%）的中国MSM样本已经使用梅毒自我检测试剂盒。我们组织了五项随机对照试验，重点是增加MSM中的HIV检测率。迄今为止，还没有研究评估MSM梅毒自我检测与基于设施的检测相比的有效性。我们的长期目标是组织一项大型的两国研究，以评估自我检测是否可以改善梅毒的诊断和治疗。作为第一步，我们将最后确定并试行一项干预措施，以促进梅毒自我检测和与临床服务的联系。这项研究将在广州（中国）和哈拉雷（津巴布韦）进行，这两个地方梅毒感染负担很高，与MSM社区组织和卫生服务有密切联系，并且正在进行艾滋病毒自我检测项目。许多研究工具和方法开发来衡量艾滋病毒自我检测可以直接应用于这项研究。我们希望，我们的中非项目将有助于在中国其他省份以及其他欠发达非洲国家采取干预措施。该项目将与正在进行的中非科技创新合作产生协同效应并从中受益。

Across a wide range of resource-constrained settings, syphilis infection causes substantial morbidity. Syphilis increases the risk of acquiring and transmitting HIV infection, but is frequently asymptomatic. Many men who have sex with men (MSM) with high risk sexual behaviours are unable to receive syphilis testing because of centralized testing sites and stigma associated with testing sites. One way to increase syphilis test uptake among MSM is syphilis self-testing. Syphilis self-testing has a person use a test kit and interpret their own test result. HIV self-testing programs have already introduced the concept of self-testing to MSM and created an infrastructure to distribute and measure uptake of self-testing. Sensitive and specific syphilis self-test kits are available and can be used to detect syphilis infection, similar to treponemal serologies commonly used in clinical practice. Syphilis self-testing could decentralize testing and decrease stigma associated with testing. Our nationwide study found that 174/699 (24.9%) of a Chinese MSM sample already use syphilis self-test kits. We have organized five randomized controlled trials focused on increasing HIV test uptake among MSM.To date, there have been no studies evaluating the efficacy of MSM syphilis self-testing compared to facility-based testing. Our long-term goal is to organize a large two-country study to evaluate if self-testing can improve syphilis diagnosis and treatment. As a first step, we will finalise and pilot an intervention to promote syphilis self-testing and linkage to clinical services. This will establish a strong foundation for a randomized controlled trial if the pilot is deemed effective.The study will take place in Guangzhou (China) and Harare (Zimbabwe), two settings with a high burden of syphilis infection, strong linkages to MSM community organizations and health services, and ongoing HIV self-testing programs. Many research tools and methods developed to measure HIV self-testing can be directly applied in this study. We expect that our China-Africa project would facilitate adoption of the intervention in both other Chinese provinces as well as other less-developed African countries. This project will synergize with and benefit from ongoing China-Africa STI collaboration.