艾滋病毒自我检测(HIVST)为夫妇和个人提供了谨慎的,方便和授权的测试选项。和所有艾滋病毒检测一样,必须预测和减轻潜在的危害,以优化个人和公共卫生利益.这里,我们描述了在马拉维实施HIVST期间报告的社会危害(SHs),并提出一个分级和应对危害的框架,根据其严重程度。
我们报告了马拉维六项HIVST实施研究(2011年至2017年)的结果,其中包括调查SH报告的子研究。定性方法包括焦点小组讨论,深入访谈和关键事件访谈。早期的研究使用了密集的定量方法(亲密伴侣暴力的测后问卷,家庭调查,调查HIVST社区的所有死亡事件)。后来的研究使用了有/没有社区参与的上市后报告。使用药物警戒方法(将潜在危及生命/变化事件定义为“严重”)对SH严重程度进行分级,假设对严重事件进行更完整的被动报告。
在分发175,683个HIVST试剂盒期间,主要在被动SH报告下,从19名(0.011%)自我测试人员中报告了25例严重的SHs,包括八对新发现的艾滋病毒不一致夫妇中的15名伴侣,和一名围产期感染的青少年。没有死亡或自杀。婚姻破裂是最常见的严重SH(16个人;8对夫妇),特别是在血清不一致的夫妇中。在新的HIV阳性夫妇中,责备和沮丧是常见的,但很少(一集)导致严重的SHs。在一致的HIV阴性夫妇中,据报道,信任增加,关系加强。在既定夫妇中,强制测试或披露通常被认为是“善意的”。妇女在向伴侣提供HIVST测试包时感到有能力和自信。一些说服伴侣进行测试的女性,然而,确实报告了SHs,包括口头或身体虐待和经济困难。
经过六年多的大规模HIVST实施和对马拉维SHs的深入调查,我们发现每10,000个HIVST试剂盒中大约有一个严重的SH报告,主要是已婚血清不和谐夫妇的分手。“主动”和“被动”报告系统均识别出严重的SH事件,尽管“活动”系统具有更完整的捕获功能。随着HIVST的扩大,应将支持和进一步优化社区主导的SH监测的努力与HIVST的分发放在优先位置。
HIV self-testing (HIVST) provides couples and individuals with a discreet, convenient and empowering testing option. As with all HIV testing, potential harms must be anticipated and mitigated to optimize individual and public health benefits. Here, we describe social harms (SHs) reported during HIVST implementation in Malawi, and propose a framework for grading and responding to harms, according to their severity.
We report findings from six HIVST implementation studies in Malawi (2011 to 2017) that included substudies investigating SH reports. Qualitative methods included focus group discussions, in-depth interviews and critical incident interviews. Earlier studies used intensive quantitative methods (post-test questionnaires for intimate partner violence, household surveys, investigation of all deaths in HIVST communities). Later studies used post-marketing reporting with/without community engagement. Pharmacovigilance methodology (whereby potentially life-threatening/changing events are defined as \"serious\") was used to grade SH severity, assuming more complete passive reporting for serious events.
During distribution of 175,683 HIVST kits, predominantly under passive SH reporting, 25 serious SHs were reported from 19 (0.011%) self-testers, including 15 partners in eight couples with newly identified HIV discordancy, and one perinatally infected adolescent. There were no deaths or suicides. Marriage break-up was the most commonly reported serious SH (sixteen individuals; eight couples), particularly among serodiscordant couples. Among new concordant HIV-positive couples, blame and frustration was common but rarely (one episode) led to serious SHs. Among concordant HIV-negative couples, increased trust and stronger relationships were reported. Coercion to test or disclose was generally considered \"well-intentioned\" within established couples. Women felt empowered and were assertive when offering HIVST test kits to their partners. Some women who persuaded their partner to test, however, did report SHs, including verbal or physical abuse and economic hardship.
After more than six years of large-scale HIVST implementation and in-depth investigation of SHs in Malawi, we identified approximately one serious reported SH per 10,000 HIVST kits distributed, predominantly break-up of married serodiscordant couples. Both \"active\" and \"passive\" reporting systems identified serious SH events, although with more complete capture by \"active\" systems. As HIVST is scaled-up, efforts to support and further optimize community-led SH monitoring should be prioritized alongside HIVST distribution.