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Abstract：
BACKGROUND: HIV self-testing (HIVST) has been shown to increase the uptake of HIV testing and help achieve the UNAIDS 95-95-95 targets. This study assessed the acceptability, usability (ease of use and result interpretation) and the willingness to pay for HIVST kits distributed through three distribution models, namely the community-based, PLHIV network-led and private practitioners models, in India.
METHODS: This cross-sectional study was implemented across 14 states in India between September 2021 and June 2022. All participants could choose between blood-based or oral-fluid-based test kits. Participants were shown a test-kit usage demonstration video, and pre- and post-test counselling was provided for all. Participants were followed-up after testing, and if reported reactive, were further supported for linkage to confirmatory testing and antiretroviral therapy (ART) initiation.
RESULTS: Among the 90,605 participants found eligible, 88,080 (97%) accepted an HIVST kit. Among the 87,976 who reported using an HIVST kit, 45,207 (51%) preferred a blood-based kit, and 42,120 (48%) reported testing for the first time. For future testing, 77,064 (88%) reported preferring HIVST over other HIV testing methods. Among those who used the kit, 83,308 (95%) found the kit easy to use, and 83,237 (95%) reported that the test results were easy to interpret. Among those who preferred HIVST for future use, 52,136 (69%) were willing to pay for the kit, with 35,854 (69%) of those willing to pay less than US$ 1.20. Only one instance of social harm was reported, with a participant reporting suicidal tendencies due to discord with their partner. Out of 328 participants (0.4%) who tested reactive with HIVST, 291 (89%) were linked to confirmatory testing; of these, 254 were confirmed HIV positive, and 216 (85%) successfully initiated ART.
CONCLUSIONS: Overall, we report that nearly all participants were willing to accept HIVST, found the test kits easy to use and interpret, and about two-thirds were willing to pay for HIVST. Given the high levels of acceptance and the ability to reach a large proportion of first-time testers, HIVST in India could contribute to achieving the UNAIDS first 95 and ending the HIV epidemic.
METHODS: This cross-sectional study was implemented across 14 states in India between September 2021 and June 2022. All participants could choose between blood-based or oral-fluid-based test kits. Participants were shown a test-kit usage demonstration video, and pre- and post-test counselling was provided for all. Participants were followed-up after testing, and if reported reactive, were further supported for linkage to confirmatory testing and antiretroviral therapy (ART) initiation.
RESULTS: Among the 90,605 participants found eligible, 88,080 (97%) accepted an HIVST kit. Among the 87,976 who reported using an HIVST kit, 45,207 (51%) preferred a blood-based kit, and 42,120 (48%) reported testing for the first time. For future testing, 77,064 (88%) reported preferring HIVST over other HIV testing methods. Among those who used the kit, 83,308 (95%) found the kit easy to use, and 83,237 (95%) reported that the test results were easy to interpret. Among those who preferred HIVST for future use, 52,136 (69%) were willing to pay for the kit, with 35,854 (69%) of those willing to pay less than US$ 1.20. Only one instance of social harm was reported, with a participant reporting suicidal tendencies due to discord with their partner. Out of 328 participants (0.4%) who tested reactive with HIVST, 291 (89%) were linked to confirmatory testing; of these, 254 were confirmed HIV positive, and 216 (85%) successfully initiated ART.
CONCLUSIONS: Overall, we report that nearly all participants were willing to accept HIVST, found the test kits easy to use and interpret, and about two-thirds were willing to pay for HIVST. Given the high levels of acceptance and the ability to reach a large proportion of first-time testers, HIVST in India could contribute to achieving the UNAIDS first 95 and ending the HIV epidemic.
摘要：
背景：HIV自我检测（HIVST）已被证明可以增加HIV检测的吸收，并有助于实现UNAIDS95-95-95目标。这项研究评估了可接受性，可用性（易用性和结果解释）和愿意为通过三种分销模式分发的HIVST试剂盒付费，即以社区为基础，PLHIV网络主导和私人从业者模式，在印度。
方法：这项横断面研究于2021年9月至2022年6月在印度14个州实施。所有参与者都可以在基于血液或基于口服液的测试试剂盒之间进行选择。向参与者展示了测试套件使用演示视频，并为所有人提供测试前和测试后咨询。参与者在测试后进行随访，如果报告是反应性的，进一步支持将其与验证性测试和抗逆转录病毒治疗（ART）的启动联系起来。
结果：在90,605名参与者中，88,080（97％）接受了HIVST试剂盒。在报告使用HIVST试剂盒的87,976人中，45,207（51％）首选基于血液的试剂盒，42,120（48％）首次报告了测试。为了将来的测试，77,064（88％）报告说，与其他艾滋病毒检测方法相比，更喜欢HIVST。在那些使用套件的人中，83,308（95％）发现该套件易于使用，83,237（95％）报告测试结果易于解释。在那些更喜欢将来使用HIVST的人中，52,136（69％）愿意为套件付费，其中35,854人(69%)愿意支付低于1.20美元的费用。只报告了一起社会伤害事件，参与者报告由于与伴侣的不和而有自杀倾向。在328名参与者（0.4％）的HIVST反应性测试中，291(89%)与验证性测试有关；其中，254人被确认为艾滋病毒阳性，216（85%）成功启动ART。
结论：总体而言，我们报告说，几乎所有参与者都愿意接受HIVST，发现测试套件易于使用和解释，大约三分之二的人愿意支付HIVST。鉴于接受程度高，能够接触到大比例的首次测试人员，印度的HIVST可以为实现UNAIDS的第一个95和结束艾滋病毒的流行做出贡献。
方法：这项横断面研究于2021年9月至2022年6月在印度14个州实施。所有参与者都可以在基于血液或基于口服液的测试试剂盒之间进行选择。向参与者展示了测试套件使用演示视频，并为所有人提供测试前和测试后咨询。参与者在测试后进行随访，如果报告是反应性的，进一步支持将其与验证性测试和抗逆转录病毒治疗（ART）的启动联系起来。
结果：在90,605名参与者中，88,080（97％）接受了HIVST试剂盒。在报告使用HIVST试剂盒的87,976人中，45,207（51％）首选基于血液的试剂盒，42,120（48％）首次报告了测试。为了将来的测试，77,064（88％）报告说，与其他艾滋病毒检测方法相比，更喜欢HIVST。在那些使用套件的人中，83,308（95％）发现该套件易于使用，83,237（95％）报告测试结果易于解释。在那些更喜欢将来使用HIVST的人中，52,136（69％）愿意为套件付费，其中35,854人(69%)愿意支付低于1.20美元的费用。只报告了一起社会伤害事件，参与者报告由于与伴侣的不和而有自杀倾向。在328名参与者（0.4％）的HIVST反应性测试中，291(89%)与验证性测试有关；其中，254人被确认为艾滋病毒阳性，216（85%）成功启动ART。
结论：总体而言，我们报告说，几乎所有参与者都愿意接受HIVST，发现测试套件易于使用和解释，大约三分之二的人愿意支付HIVST。鉴于接受程度高，能够接触到大比例的首次测试人员，印度的HIVST可以为实现UNAIDS的第一个95和结束艾滋病毒的流行做出贡献。
