Assessing Acceptability and Feasibility of HIV Self-Testing and Linkage to HIV Services in Zimbabwe

描述(由申请人提供)：未检测到的艾滋病毒感染和延迟诊断是由于对艾滋病毒检测和咨询(HTC)了解不足而导致的主要公共卫生问题。HTC是获得预防和护理服务的门户；然而，在资源匮乏的国家，大约60%的艾滋病毒/艾滋病患者不知道自己的状况。在津巴布韦，供应商提供的HTC(PDHTC)广泛可用，但迟诊(定义为在第一次阳性检测后一年内得到艾滋病诊断)仍然很常见，这表明许多高危个人无法获得及时的艾滋病毒检测。除了限制早期护理的临床益处外，未被发现感染的人可能会在不知情的情况下将艾滋病毒传播给伴侣。作为艾滋病毒预防和护理服务连续体的第一步，增加了解其血清状况的人数是一项优先事项。艾滋病毒自我检测，即个人收集自己的样本，在没有提供者的情况下进行简单的快速艾滋病毒检测，有可能克服阻碍PDHTC方法的一些障碍，因此可能有效地接触到在当前战略下不愿进行检测的个人。简单易用的口腔艾滋病毒检测提供了高度的敏感性和特异性，不会造成生物危害风险；因此，它们是自我检测的理想选择。尽管现有数据表明自我检测的需求量很大，准确度也很高，但我们对如何最好地实施自我检测并促进与艾滋病毒服务的联系知之甚少。迫切需要开展实施研究，特别是关于对自我检测的偏爱和接受，审查特定群体是否喜欢自我检测，并探讨自我检测是否有助于及时接触艾滋病毒服务，以及如何最好地促进这一点。我们将通过调整一个支持自我测试的系统来解决这一差距，并在津巴布韦成年人中进行试点，以评估与PDHTC相比自我测试的接受度和可接受性。在目标1中，我们将调整一套与文化相关的自我检测材料，利用书面和图片说明，结合创新的移动电话系统来支持检测和参与艾滋病毒服务，并通过在静态HTC诊所进行监督自我检测来对这些材料进行评估。在目标2中，我们将使用这些材料在城市周边社区进行观察性研究，评估自我检测和PDHTC，以比较对检测方法的偏好，并评估检测人员的关键特征以及通过检测方法与艾滋病毒服务的联系。AIM 3将提供必要的定性数据，探讨自我检测的背景方面，这对实施这一战略至关重要，包括人们如何以及在哪里进行自我检测，为什么选择自我检测，为什么要或没有与艾滋病毒服务挂钩的原因，以及围绕自我检测的潜在安全问题。该项目将生成材料和初步数据，以支持津巴布韦扩大自我检测，并可应用于其他国家。这一发现将为未来对自我检测的有效性进行大规模试验提供关键基础，以增加对艾滋病毒检测的接受和对艾滋病毒服务的参与。

DESCRIPTION (provided by applicant): Undetected HIV infection and late diagnosis are major public health issues driven by inadequate uptake of HIV testing and counseling (HTC). HTC is the gateway to prevention and care services; however, roughly 60% of people living with HIV/AIDS in resource-poor countries are unaware of their status. In Zimbabwe, provider-delivered HTC (PDHTC) is widely available, yet late diagnosis (defined as receiving an AIDS diagnosis within a year of first positive test) remains common, suggesting that many high-risk individuals are not accessing timely HIV testing. In addition to limiting the clinical benefits of early care, persons with undetected infection may unknowingly transmit HIV to partners. Increasing the number of people who are aware of their serostatus is a priority as the first step on the continuum of HIV prevention and care services. HIV self-testing, where an individual collects their own sample and performs a simple rapid HIV test in the absence of a provider, has the potential to overcome a number of barriers hindering PDHTC approaches, and may therefore be effective at reaching individuals who are reluctant to test under current strategies. Simple-to-use oral HIV tests offer high sensitivity and specificity and do not pose a biohazard risk; consequently, they are ideal for self-testing. Though existing data indicate high demand and good accuracy of self-testing, we know little about how best to operationalize self-testing and facilitate linkage to HIV services. There is an urgent need for implementation research, particularly regarding preference for and uptake of self-testing, examining whether particular groups favor self-testing and exploring whether self- testing leads to timely engagement with HIV services and how best to facilitate this. We will address this gap by adapting a system to support self-testing and piloting this among adults in Zimbabwe to assess uptake and acceptability of self-testing compared with PDHTC. In Aim 1, we will adapt a culturally relevant set of self-testing materials that utilizes written and pictorial instructions, coupled with an innovative mobile phone system to support testing and engagement with HIV services, and evaluate these through supervised self-testing in a static HTC clinic. In Aim 2, we will use these materials to conduct an observational study in peri-urban communities, evaluating self-testing versus PDHTC to compare preference for testing methods and to assess key characteristics of testers and linkage to HIV services by testing method. Aim 3 will provide essential qualitative data exploring contextual aspects of self-testing, which will be critical to operationalizing this strategy, including how and where people self-test, why they opt to self- test, reasons why they did or did not link to HIV services, and potential safety concerns around self-testing. This project will generate materials and preliminary data to support scale-up of self-testing in Zimbabwe that could be applied to other countries. The findings will provide a critical foundation for future large-scale trials of the effectiveness of self-testing to increase uptake of HIV testin and engagement in HIV services.