背景:过去的研究表明,相对于临床测试,HIV自我测试(HIVST)可以增加测试并促进更多的HIV诊断。然而,在美国,由于担心使用HIVST的人不太可能与护理相关,因此HIVST的使用受到限制.
方法:从2019年1月到2022年4月,我们在美国招募了811名与男性发生性关系的男性(MSM),他们使用在线营销活动进行了不频繁的测试,并将他们随机分配为1:1:1,在一年中每3个月接受以下一项:(1)短信提醒,以在当地诊所(对照)进行测试;(2)邮寄HIVST试剂盒季度跟踪调查评估艾滋病毒检测,性传播感染(STI)检测,暴露前预防(PrEP)使用和性危险行为。
结果:八名参与者被诊断为HIV,除了一个人都是通过HIVST的.在HIVST条件下的参与者,标准或eTest,与对照组相比,在12个月内进行任何测试(OR=7.9,95%CI=4.9-12.9,OR=6.6,95%CI=4.2-10.5)和重复测试(>1检验;OR=8.5,95%CI=5.7-12.6;OR=8.9,95%CI=6.1-13.4)的几率显著较高.STI测试和PrEP摄取率在不同研究条件下没有差异,但与其他组相比,在整个研究期间,接受eTest条件的患者报告的性风险事件减少了27%。
结论:HIVST大大增加了测试,鼓励在MSM中进行更定期的测试,发现了几乎所有的新病例,表明HIVST可以更早地诊断HIV感染。在HIVST后提供及时的随访咨询并没有增加STI检测或PrEP的使用率,但是一些证据表明,咨询可能减少了性风险行为。为了鼓励更优化的测试,计划应定期将HIVST和运输套件直接纳入收件人。
BACKGROUND: Past research shows that HIV self-testing (HIVST) can increase testing and facilitate more HIV diagnoses relative to clinic testing. However, in the United States, the use of HIVSTs is limited due to concerns that those who use HIVST could be less likely to be linked to care.
METHODS: From January 2019 to April 2022, we recruited 811 men who have sex with men (MSM) in the United States who tested infrequently using an online marketing campaign and randomized them 1:1:1 to receive one of the following every 3 months for a year: (1) text message reminders to get tested at a local clinic (control); (2) mailed HIVST kits with access to a free helpline (standard HIVST); and (3) mailed HIVST kits with counselling provided within 24 hours of opening a kit (eTest). Quarterly follow-up surveys assessed HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) use and sexual risk behaviour.
RESULTS: Eight participants were diagnosed with HIV, and all but one were through HIVST. Participants in either HIVST condition, standard or eTest, had significantly higher odds of any testing (OR = 7.9, 95% CI = 4.9-12.9 and OR = 6.6, 95% CI = 4.2-10.5) and repeat testing (>1 test; OR = 8.5, 95% CI = 5.7-12.6; OR = 8.9, 95% CI = 6.1-13.4) over 12 months relative to the control group. Rates of STI testing and PrEP uptake did not differ across study condition, but those in the eTest condition reported 27% fewer sexual risk events across the study period relative to other groups.
CONCLUSIONS: HIVST vastly increased testing, encouraged more regular testing among MSM, and identified nearly all new cases, suggesting that HIVST could diagnose HIV acquisition earlier. Providing timely follow-up counselling after HIVST did not increase rates of STI testing or PrEP use, but some evidence suggested that counselling may have reduced sexual risk behaviour. To encourage more optimal testing, programmes should incorporate HIVST and ship kits directly to recipients at regular intervals.