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Abstract：
BACKGROUND: Understanding how HIV self-testing (HIVST) can meet the testing needs of gay, bisexual and other men who have sex with men (GBMSM) and trans people whose social networks vary is key to upscaling HIVST implementation. We aim to develop a contextual understanding of social networks and HIV testing needs among GBMSM (cis and transgender) and trans women in SELPHI (An HIV Self-testing Public Health Intervention), the UK\'s largest randomised trial on HIVST.
METHODS: This study re-analysed qualitative interviews conducted from 2015 to 2020. Forty-three in-person interviews were thematically analysed using the Framework Method. Our analytic matrix inductively categorised participants based on the unmet needs for HIV testing and the extent of social network support. The role of social networks on HIVST behaviour was explored based on individuals\' testing trajectories.
RESULTS: Four distinct groups were identified based on their unmet testing needs and perceived support from social networks. Optimisation advocates (people with high unmet needs and with high network support, n = 17) strived to tackle their remaining barriers to HIV testing through timely support and empowerment from social networks. Privacy seekers (people with high unmet needs and with low network support, n = 6) prioritised privacy because of perceived stigma. Opportunistic adopters (people with low unmet needs and with high network support, n = 16) appreciated social network support and acknowledged socially privileged lives. Resilient testers (people with low unmet needs and with low network support, n = 4) might hold potentially disproportionate confidence in managing HIV risks without sustainable coping strategies for potential seroconversion. Supportive social networks can facilitate users\' uptake of HIVST by: (1) increasing awareness and positive attitudes towards HIVST, (2) facilitating users\' initiation into HIVST with timely support and (3) affording participants an inclusive space to share and discuss testing strategies.
CONCLUSIONS: Our proposed categorisation may facilitate the development of differentiated person-centred HIVST programmes. HIVST implementers should carefully consider individuals\' unmet testing needs and perceived levels of social support, and design context-specific HIVST strategies that link people lacking supportive social networks to comprehensive HIV care.
METHODS: This study re-analysed qualitative interviews conducted from 2015 to 2020. Forty-three in-person interviews were thematically analysed using the Framework Method. Our analytic matrix inductively categorised participants based on the unmet needs for HIV testing and the extent of social network support. The role of social networks on HIVST behaviour was explored based on individuals\' testing trajectories.
RESULTS: Four distinct groups were identified based on their unmet testing needs and perceived support from social networks. Optimisation advocates (people with high unmet needs and with high network support, n = 17) strived to tackle their remaining barriers to HIV testing through timely support and empowerment from social networks. Privacy seekers (people with high unmet needs and with low network support, n = 6) prioritised privacy because of perceived stigma. Opportunistic adopters (people with low unmet needs and with high network support, n = 16) appreciated social network support and acknowledged socially privileged lives. Resilient testers (people with low unmet needs and with low network support, n = 4) might hold potentially disproportionate confidence in managing HIV risks without sustainable coping strategies for potential seroconversion. Supportive social networks can facilitate users\' uptake of HIVST by: (1) increasing awareness and positive attitudes towards HIVST, (2) facilitating users\' initiation into HIVST with timely support and (3) affording participants an inclusive space to share and discuss testing strategies.
CONCLUSIONS: Our proposed categorisation may facilitate the development of differentiated person-centred HIVST programmes. HIVST implementers should carefully consider individuals\' unmet testing needs and perceived levels of social support, and design context-specific HIVST strategies that link people lacking supportive social networks to comprehensive HIV care.
摘要：
背景：了解艾滋病毒自我检测（HIVST）如何满足同性恋的检测需求，双性恋和其他与男性发生性关系的男性（GBMSM）和社交网络各不相同的跨性别者是扩大HIVST实施的关键。我们的目标是在SELPHI（HIV自我检测公共卫生干预）中发展对GBMSM（顺式和跨性别者）和跨性别妇女之间的社交网络和HIV检测需求的上下文理解，英国最大的HIVST随机试验。
方法：本研究重新分析了2015年至2020年进行的定性访谈。使用框架方法对43次面对面访谈进行了主题分析。我们的分析矩阵根据未满足的HIV检测需求和社交网络支持程度对参与者进行了归纳分类。基于个人测试轨迹，探索了社交网络对HIVST行为的作用。
结果：根据未满足的测试需求和社交网络的感知支持，确定了四个不同的群体。优化倡导者(具有高度未满足需求和高度网络支持的人，n=17）通过社交网络的及时支持和赋权，努力解决他们在艾滋病毒检测方面的剩余障碍。隐私寻求者（具有高度未满足的需求和低网络支持的人，n=6）由于感知到的污名而优先考虑隐私。机会主义者(未满足需求低且网络支持高的人，n=16）赞赏社交网络支持并承认社会特权生活。弹性测试人员（未满足需求低且网络支持低的人员，n=4）在没有针对潜在血清转换的可持续应对策略的情况下，可能对管理HIV风险抱有不成比例的信心。支持性社交网络可以通过以下方式促进用户对HIVST的吸收：（1）提高对HIVST的认识和积极态度，（2）在及时的支持下促进用户进入HIVST；（3）为参与者提供一个共享和讨论测试策略的包容性空间。
结论：我们提出的分类可能会促进以人为中心的HIVST计划的发展。HIVST实施者应仔细考虑个人未满足的测试需求和感知的社会支持水平，并设计针对特定环境的HIVST策略，将缺乏支持性社交网络的人与全面的HIV护理联系起来。
方法：本研究重新分析了2015年至2020年进行的定性访谈。使用框架方法对43次面对面访谈进行了主题分析。我们的分析矩阵根据未满足的HIV检测需求和社交网络支持程度对参与者进行了归纳分类。基于个人测试轨迹，探索了社交网络对HIVST行为的作用。
结果：根据未满足的测试需求和社交网络的感知支持，确定了四个不同的群体。优化倡导者(具有高度未满足需求和高度网络支持的人，n=17）通过社交网络的及时支持和赋权，努力解决他们在艾滋病毒检测方面的剩余障碍。隐私寻求者（具有高度未满足的需求和低网络支持的人，n=6）由于感知到的污名而优先考虑隐私。机会主义者(未满足需求低且网络支持高的人，n=16）赞赏社交网络支持并承认社会特权生活。弹性测试人员（未满足需求低且网络支持低的人员，n=4）在没有针对潜在血清转换的可持续应对策略的情况下，可能对管理HIV风险抱有不成比例的信心。支持性社交网络可以通过以下方式促进用户对HIVST的吸收：（1）提高对HIVST的认识和积极态度，（2）在及时的支持下促进用户进入HIVST；（3）为参与者提供一个共享和讨论测试策略的包容性空间。
结论：我们提出的分类可能会促进以人为中心的HIVST计划的发展。HIVST实施者应仔细考虑个人未满足的测试需求和感知的社会支持水平，并设计针对特定环境的HIVST策略，将缺乏支持性社交网络的人与全面的HIV护理联系起来。
