Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial


Autoři: Ci Zhang aff001;  Deborah Koniak-Griffin aff002;  Han-Zhu Qian aff001;  Lloyd A. Goldsamt aff004;  Honghong Wang aff001;  Mary-Lynn Brecht aff002;  Xianhong Li aff001
Působiště autorů: Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China aff001;  School of Nursing, University of California at Los Angeles, Los Angeles, California, United States of America aff002;  School of Public Health, Yale University, New Haven, Connecticut, United States of America aff003;  Rory Meyers College of Nursing, New York University, New York, New York, United States of America aff004
Vyšlo v časopise: Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial. PLoS Med 17(10): e32767. doi:10.1371/journal.pmed.1003365
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003365

Souhrn

Background

The HIV epidemic is rapidly growing among men who have sex with men (MSM) in China, yet HIV testing remains suboptimal. We aimed to determine the impact of HIV self-testing (HIVST) interventions on frequency of HIV testing among Chinese MSM and their sexual partners.

Methods and findings

This randomized controlled trial was conducted in 4 cities in Hunan Province, China. Sexually active and HIV-negative MSM were recruited from communities and randomly assigned (1:1) to intervention or control arms. Participants in the control arm had access to site-based HIV testing (SBHT); those in the intervention arm were provided with 2 free finger-prick-based HIVST kits at enrollment and could receive 2 to 4 kits delivered through express mail every 3 months for 1 year in addition to SBHT. They were encouraged to distribute HIVST kits to their sexual partners. The primary outcome was the number of HIV tests taken by MSM participants, and the secondary outcome was the number of HIV tests taken by their sexual partners during 12 months of follow-up. The effect size for the primary and secondary outcomes was evaluated as the standardized mean difference (SMD) in testing frequency between intervention and control arms.

Between April 14, 2018, and June 30, 2018, 230 MSM were recruited. Mean age was 29 years; 77% attended college; 75% were single. The analysis population who completed at least one follow-up questionnaire included 110 (93%, 110/118) in the intervention and 106 (95%, 106/112) in the control arm. The average frequency of HIV tests per participant in the intervention arm (3.75) was higher than that in the control arm (1.80; SMD 1.26; 95% CI 0.97–1.55; P < 0.001). This difference was mainly due to the difference in HIVST between the 2 arms (intervention 2.18 versus control 0.41; SMD 1.30; 95% CI 1.01–1.59; P < 0.001), whereas the average frequency of SBHT was comparable (1.57 versus 1.40, SMD 0.14; 95% CI −0.13 to 0.40; P = 0.519). The average frequency of HIV tests among sexual partners of each participant was higher in intervention than control arm (2.65 versus 1.31; SMD 0.64; 95% CI 0.36–0.92; P < 0.001), and this difference was also due to the difference in HIVST between the 2 arms (intervention 1.41 versus control 0.36; SMD 0.75; 95% CI 0.47–1.04; P < 0.001) but not SBHT (1.24 versus 0.96; SMD 0.23; 95% CI −0.05 to 0.50; P = 0.055). Zero-inflated Poisson regression analyses showed that the likelihood of taking HIV testing among intervention participants were 2.1 times greater than that of control participants (adjusted rate ratio [RR] 2.10; 95% CI 1.75–2.53, P < 0.001), and their sexual partners were 1.55 times more likely to take HIV tests in the intervention arm compared with the control arm (1.55, 1.23–1.95, P < 0.001). During the study period, 3 participants in the intervention arm and none in the control arm tested HIV positive, and 8 sexual partners of intervention arm participants also tested positive. No other adverse events were reported. Limitations in this study included the data on number of SBHT were solely based on self-report by the participants, but self-reported number of HIVST in the intervention arm was validated; the number of partner HIV testing was indirectly reported by participants because of difficulties in accessing each of their partners.

Conclusions

In this study, we found that providing free HIVST kits significantly increased testing frequency among Chinese MSM and effectively enlarged HIV testing coverage by enhancing partner HIV testing through distribution of kits within their sexual networks.

Trial registration

Chinese Clinical Trial Registry ChiCTR1800015584.

Klíčová slova:

Cities – Ethnicities – HIV – HIV epidemiology – China – Men who have sex with men – Randomized controlled trials – Virus testing


Zdroje

1. UNAIDS. Global HIV & AIDS statistics-2019 fact sheet. 2019. [Cited 2020 February 6]. Available from: https://www.unaids.org/en/resources/fact-sheet

2. UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. 2017. [cited 2020 Feb 6]. Available from: https://www.unaids.org/en/resources/documents/2017/90-90-90

3. Centers for Disease Control and Prevention. HIV Surveillance Report. 2018; 30. [cited 2020 Feb 6]. Available from: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-vol-30.pdf

4. WHO. Consolidated guidelines on HIV testing services: 5Cs: consent, confidentiality, counselling, correct results and connection. 2015 Jul. [cited 2020 Feb 6]. Available from: https://www.who.int/hiv/pub/guidelines/hiv-testing-services/en/

5. Zhang X, Wang N, Vermund SH, Zou H, Li X, Zhang F, et al. Interventions to improve the HIV continuum of care in China. Curr HIV/AIDS Rep. 2019;16(6):448–57. doi: 10.1007/s11904-019-00469-y 31776975

6. General Office of the State Council of China. The 13th five-year action plan for HIV/AIDS control and prevention in China. 2017 Jan 19. [cited 2020 Feb 6]. Available from: http://www.gov.cn/gongbao/content/2017/content_5171331.htm

7. Zou H, Hu N, Xin Q, Beck J. HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav. 2012;16(7):1717–28. doi: 10.1007/s10461-012-0225-y 22677975

8. Chinese AIDS Prevention Center. Promotional materials on HIV testing and consultation. 2019. [cited 2020 Feb 6]. Available from: http://www.chain.net.cn/info_view/13247/

9. Patel RR, Patel S, Clarke E, Khan AW, Doshi B, Radcliffe KW. Guidance and practice on frequency of HIV and sexually transmitted infection testing in men who have sex with men—what is the European situation? Int J STD AIDS. 2014;25(3):213–8. doi: 10.1177/0956462413497700 24216033

10. Tang W, Han L, Best J, Zhang Y, Mollan K, Kim J, et al. Crowdsourcing HIV test promotion videos: a noninferiority randomized controlled trial in China. Clin Infect Dis. 2016;62(11):1436–1442. doi: 10.1093/cid/ciw171 27129465

11. Zhu X, Zhang W, Operario D, Zhao Y, Shi A, Zhang Z, et al. Effects of a mobile health intervention to promote HIV self-testing with MSM in China: a randomized controlled trial. AIDS Behav. 2019;23(11):3129–39. doi: 10.1007/s10461-019-02452-5 30852728

12. Tao J, Li M, Qian H, Wang L, Zhang Z, Ding H, et al. Home-based HIV Testing for Men Who Have Sex With Men in China: A Novel Community-Based Partnership to Complement Government Programs. PLoS ONE. 2014 Jul 22;9(7):e102812. doi: 10.1371/journal.pone.0102812 25051160

13. Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, et al. Acceptability and feasibility of a social entrepreneurship testing model to promote HIV self-testing and linkage to care among men who have sex with men. HIV Med. 2017;18(5):376–82. doi: 10.1111/hiv.12437 27601301

14. Valdiserri RO. Late HIV diagnosis: bad medicine and worse public health. PLoS Med. 2007;4(6):e200. doi: 10.1371/journal.pmed.0040200 17564489

15. UNAIDS. UNAIDS DATA 2020. 2020 July. [cited 2020 Sep 23]. Available from: https://www.unaids.org/en/resources/documents/2020/unaids-data

16. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet HIV. 2019;393(10189):2428–38.

17. Bavinton B, Pinto A, Phanuphak N, Grinsztejn B, Prestage G, Zablotska-Manos I, et al. Viral Suppression and HIV Transmission in Serodiscordant Male Couples: An International, Prospective, Observational, Cohort Study. Lancet HIV. 2018 Aug;5(8):e438–e447. doi: 10.1016/S2352-3018(18)30132-2 30025681

18. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016;316(2):171–81. doi: 10.1001/jama.2016.5148 27404185

19. Liu Y, Sun X, Qian HZ, Yin L, Yan Z, Wang L, et al. Qualitative assessment of barriers and facilitators of access to HIV testing among men who have sex with men in China. AIDS Patient Care STDS. 2015;29(9):481–9. doi: 10.1089/apc.2015.0083 26186029

20. Figueroa C, Johnson C, Verster A, Baggaley R. Attitudes and Acceptability on HIV self-testing among key populations: a literature review. AIDS Behav. 2015; 19(11):1949–1965. doi: 10.1007/s10461-015-1097-8 26054390

21. Katz DA, Golden MR, Hughes JP, Farquhar C, Stekler JD. HIV self-testing increases HIV testing frequency in high-risk men who have sex with men: a randomized controlled trial. J Acquir Immune Defic Syndr. 2018;78(5):505–12. doi: 10.1097/QAI.0000000000001709 29697595

22. Jamil MS, Prestage G, Fairley CK, Grulich AE, Smith KS, Chen M, et al. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. Lancet HIV. 2017;4(6):e241–e50. doi: 10.1016/S2352-3018(17)30023-1 28219619

23. MacGowan RJ, Chavez PR, Borkowf CB, Owen SM, Purcell DW, Mermin JH, et al. Effect of internet-distributed HIV self-tests on HIV diagnosis and behavioral outcomes in men who have sex with men: a randomized clinical trial. JAMA Intern Med. 2019 Nov 18. doi: 10.1001/jamainternmed.2019.5222 [Epub ahead of print] 31738378

24. Wang Z, Lau JTF, Ip M, Ho SPY, Mo PKH, Latkin C, et al. A randomized controlled trial evaluating efficacy of promoting a home-based HIV self-testing with online counseling on increasing HIV testing among men who have sex with men. AIDS Behav. 2018;22(1):190–201. doi: 10.1007/s10461-017-1887-2 28831616

25. WHO. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. 2016 Dec. [cited 2020 Feb 6]. Available from: https://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/

26. Yan L, Xiao PP, Yan HJ, Huan XP, Fu GF, Li JJ, et al. [The advance of detection technology of HIV self-testing]. Zhonghua Yu Fang Yi Xue Za Zhi. 2017;51(11):1053–6. doi: 10.3760/cma.j.issn.0253-9624.2017.11.020 29136756

27. WHO. Guidance on couples HIV testing and counselling including antiretroviral therapy for treatment and prevention in serodiscordant couples: recommendations for a public health approach. 2012 Apr. [cited 2020 Feb 6]. Available from: https://www.who.int/hiv/pub/guidelines/9789241501972/en/

28. Thirumurthy H, Masters SH, Mavedzenge SN, Maman S, Omanga E, Agot K. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV. 2016;3(6):e266–74. doi: 10.1016/S2352-3018(16)00041-2 27240789

29. UNAIDS. UNAIDS data. 2017. [cited 2020 Feb 6]. Available from: https://www.unaids.org/en/resources/documents/2017/2017_data_book

30. Sharma A, Chavez PR, MacGowan RJ, McNaghten AD, Mustanski B, Gravens L, et al. Willingness to distribute free rapid home HIV test kits and to test with social or sexual network associates among men who have sex with men in the United States. AIDS Care. 2017;29(12):1499–503. doi: 10.1080/09540121.2017.1313386 28393612

31. Zhang C, Li X, Koniak-Griffin D, Goldsamt LA, Zhou J. Effectiveness of self-testing kits availability on improving HIV testing frequency for Chinese men who have sex with men and their sexual partners: a protocol for a multicenter randomised controlled trial. BMJ Open. 2018;8(12):e024423. doi: 10.1136/bmjopen-2018-024423 30552280

32. Wang XD JC, Ma H. Rating scales for mental health. Chinese J Mental Health. 1999:127–130.

33. Huang ZL SF, Yan RL. Analysis of HIV/AIDS high risk behavior and influencing factors among men who have sex with men in Changsha. Practical Preventive Med. 2013;20:1435–8.

34. Alere. Alere determine HIV-1/2 quick reference card-global (English). 2019. [cited 2020 Feb 6]. Available from: https://www.alere.com/zh/zh/product-details/determine-hiv-1-2.html

35. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175–91. doi: 10.3758/bf03193146 17695343

36. Van BS, Groothuis-Oudshoorn K. mice: Multivariate Imputation by Chained Equations in R. Journal of Statistical Software. 2011;45(3):1–67.

37. Mark J, Kinuthia J, Roxby AC, Krakowiak D, Osoti A, Richardson BA, et al. Uptake of home-based syphilis and human immunodeficiency virus testing among male partners of pregnant women in western Kenya. Sex Transm Dis. 2017;44(9):5338.

38. Zou H, Wu Z, Yu J, Reilly KH, Zhang CM, Yun K, et al. Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Beijing and Urumqi, China. J Acquir Immune Defic Syndr. 2010;53 Suppl 1(Suppl 1):S81–7.


Článek vyšel v časopise

PLOS Medicine


2020 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Imunitní trombocytopenie (ITP) u dospělých pacientů
nový kurz
Autoři: prof. MUDr. Tomáš Kozák, Ph.D., MBA

Pěnová skleroterapie
Autoři: MUDr. Marek Šlais

White paper - jak vidíme optimální péči o zubní náhrady
Autoři: MUDr. Jindřich Charvát, CSc.

Hemofilie - série kurzů

Faktory ovlivňující léčbu levotyroxinem
Autoři:

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

VIRTUÁLNÍ ČEKÁRNA ČR Jste praktický lékař nebo pediatr? Zapojte se! Jste praktik nebo pediatr? Zapojte se!

×