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

项目名称 女性性工作者二次分发HIV自检：促进男性的创新战略 合作伙伴检测和降低艾滋病毒风险。 项目摘要/摘要 在可能感染艾滋病毒的人中更多地接受艾滋病毒检测对于满足第一届联合国艾滋病规划署至关重要 “90-90-90”目标。然而，在撒哈拉以南非洲，大约55%的艾滋病毒感染者仍然不知道 他们的血清状态，男性的意识低于女性。虽然以社区为基础的艾滋病毒检测 战略在促进普通人群艾滋病毒检测方面取得了相当大的成功，但有必要 用于创新的艾滋病毒检测战略，可以接触到关键人群和高危个人，如男性 女性性工作者的伴侣。还需要采取干预措施来促进夫妇检测，这可能会导致 改善性决策，包括增加避孕套的使用和增加抗逆转录病毒治疗的使用 防止性传播。艾滋病毒自我检测是一种有希望的方法，它有可能大幅 以保密和授权用户的方式增加对测试的访问。来自全球各地的数据 GLOBAL显示了广泛人群对自我测试的高度兴趣和可接受性。 尽管艾滋病毒自我检测对那些不定期重复检测的人来说是一个很好的选择，但几乎没有 了解最佳分发策略，以促进最难接触到的个人使用自测。 一种创新的策略是“二次分发”艾滋病毒自我检测，即一个人被给予多次 自我测试可以将它们分发给性伴侣或他们社交网络中的其他人。该项目将评估 肯尼亚女性性工作者二次分发自我检测能否被用来实现多重艾滋病毒 预防目标，包括促进在高危男子中进行艾滋病毒检测和促进相互 披露血清状态、夫妻检测和更安全的性行为决策。通过促进更安全的性行为 决策，二次分发自我测试有可能降低女性的艾滋病毒发病率 性工作者，这一人群面临着感染艾滋病毒的特别高风险。基于以下项目的初步数据 证明女性性工作者可以安全地向她们的性伴侣分发口头自我测试，并做出 在自我测试之后，我们将进行一项随机对照试验，其中 女性性工作者被随机安排接受多项自我测试或一张代金券，以便将性伴侣转介到诊所 艾滋病毒检测。在目标1中，我们将测试女性性工作者二次分发自我测试是否会导致 更多地识别感染艾滋病毒的男性和更安全的性行为。在目标2中，我们将深入进行 访谈以评估研究参与者将自我测试分发给他们的性伴侣的经历。在目标3中，我们 将决定女性性工作者二次分发自我检测的成本效益。该项目 将有助于确定艾滋病毒自我检测是否有助于促进多种艾滋病毒预防目标。会的 还为撒哈拉以南非洲国家的自我测试的最佳分配战略提供指导 制定艾滋病毒自我检测政策，扩大自我检测的可获得性。

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.