| BackgroundIn recent years,lots of areas in China have expanded the coverage of HIV testing in high-risk populations through providing online appointment for HIV testing combined with the Internet,which could promote "Early detection,early diagnosis,and early treatment".Under the support of the National Key Science and Technology fund,the Chinese CDC cooperated with Blued,a gay dating app,to set up a HIV booking platform called “Happy Testing” in 20 cities from 6 provinces in China to provide Appbased HIV testing services(AHTS)for men who have sex with men(MSM)in targeted cities.AHTS is an innovated HIV testing service which is integrated with online appointment and offline facility testing efficiently.The program fully utilized the advantages of standardized platform,further promoting the coverage of HIV testing in high-risk populations by optimizing the traditional HIV testing models.However,the outbreak of COVID-19 pandemic during the program has exerted profound impact in various aspects in society and daily life.As an innovated HIV testing service which could connect different regions through online information system,more practices and theories are needed for further implementation in other places in China.In addition,the degree of influence of COVID-19 pandemic on this type of online service is still unclear.Our study selected Shijiazhuang as a case city to evaluate the effect of conducting AHTS among MSM in qualitative and quantative perspective as well as exploring the impact of COVID-19 on HIV testing services.Objective(1)Exploring the influencing factors of providing AHTS for MSM in Shijiazhuang through a qualitative study design;(2)Evaluating the implementation of AHTS for MSM in Shijiazhuang through a quantative study design;(3)Elucidating the impact of COVID-19-related policies on identifying HIV/AIDS cases in China and estimating the potential loss on the report of cases;(4)Based on the results above,providing theoretical basis and empirical reference for implementation of AHTS in other areas from China as well as the allocation and utilization of medial resources on HIV testing under public health emergency.MethodsStudy Ⅰ: As a qualitative interview study,21 AHTS provider staff(11 individuals from CDC and 10 individuals from NGO)were enrolled between December 2021 and January 2022.And 13 MSM formly receiving AHTS were enrolled between February2022 and April 2022.The AHTS provider staff were enrolled through two senior staff members from Shijiazhuang CDC and the head of NGO institutions,and MSM were enrolled by the NGO.The individual semi-structured interviews were conducted with study participants using self-made interview outlines to collect the facilitators and barriers on providing AHTS based on the perspectives from service providers and recipients.Data was summarized and analyzed using thematic analysis.The study results could identify the influencing factors of implementation of AHTS in Shijiazhuang and provide suggestions on the optimization of this service in perspectives of qualitative interview studies.Study Ⅱ: In this study,the number of active tests for HIV from July 2016 to June2022 in Shijiazhuang CDC and NGO was collected to evaluate the influence of AHTS on the number of active tests for HIV in MSM from Shijiazhaung before and after the COVID-19 pandemic.We constructed seasonal autoregressive integrated moving average intervention model(SARIMA-Intervention)and introduced AHTS-related variables and indices from the Oxford COVID-19 Government Response Tracker(Ox CGRT)into the model to estimate the effect of AHTS implementation during COVID-19 pandemic in a quantative perspective.The degree of COVID-19 related policies in Shijiazhuang was estimated through the Ox CGRT.Study Ⅲ: This study aimed to explore the influence of polices related to COVID-19 control and prevention on identifying monthly reported HIV/AIDS cases in China and evaluated the potential loss on case reporting with the interrupted time series study design.The SARIMA intervention model was constructed to evaluate the effect of COVID-19 related polices on monthly reported HIV/AIDS cases and predicted the numbers in subsequent months.The degree of COVID-19 related policies was estimated through Ox CGRT.Furthermore,a counterfactual model was built to compare the estimated HIV/AIDS case numbers if COVID-19 hadn’t occurred in December2019 with actual numbers.ResultsStudy Ⅰ: A total of 21 AHTS providers(ranging from 19-70 years old)and 13recipients(ranging from 21-52 years old)were finally included in our study.The service providers consisted of 10 individuals from CDC and 11 individuals from NGO.The service providers reported that the facilitators of conducting AHTS included acceptability of online information system,convenience in services,facilitating peer mobilization,digital management of information,enhancing testing efficiency,covering high-risk MSM,the dissemination of AHTS-related information and stimulating the evaluation of HIV testing policy.The service recipients reported that the facilitators of conducting AHTS included acceptability of online information system,convenience in services,facilitating peer mobilization,reducing interpersonal contact,enhancing testing efficiency and the dissemination of AHTS-related information.Additionally,the service providers indicated several barriers of AHTS,including operations of online services,the usage of online platform,personal characteristics of MSM(such as concerns about information security,fear of the possibility of positive results,etc.),trust of testing facilities,difficulties in effective communication,heavy workload,distribution of AHTS sites,effect of other testing services,the authority of online platform and the impact of COVID-19 related policies on AHTS.In perspectives from AHTS recipients,the barriers are as follows: operations of online services,the usage of online platform,personal characteristics of MSM(such as concerns about information security,fear of the possibility of positive results,etc.),trust of testing facilities,difficulties in effective communication,distribution of AHTS sites,effect of other testing services and the impact of COVID-19 related policies on AHTS.Although the AHTS has brought convieniences for HIV testing facilities and MSM especially among young MSM due to its utilization of the online platform,it still faces series of challenges.Using online platform could induce the worries about information security among MSM and limite the coverage of AHTS among elderly MSM.Additionally,the potential impact of COVID-19 pandemic on AHTS is still unclear,which needs subsequent studies to clarify.Study Ⅱ: The COVID-19-related polices were associated with the decrease of monthly number of active tests in MSM from Shijiazhuang,whereas we did not find the association between the implementation of AHTS and the monthly number of active tests.The results are listed below:(1)The monthly reported number of active tests for HIV were inversely and significantly associated with the enforcement of stricter lockdown and COVID-19 related polices in Shijiazhuag(Coefficient for Stringency Index from Ox CGRT =-29.130,95%CI:-44.327,-13.934);(2)We did not find the association between economic support polices in Shijiazhuang and the monthly number of active tests for HIV(Coefficient for Economic Support Index from Ox CGRT =7.518,95% CI:-13.236,28.272);(3)We also did not find the association between the implementation of AHTS in Shijiazhuang and the monthly number of active tests for HIV(Coefficient for implementation of AHTS =-7.668,95% CI:-20.813,5.477).Study Ⅲ: We have found that the enforcement of stricter COVID-19 containment policies was associated with the decrease of monthly reported numbers of HIV/AIDS cases.And the counterfactual model identified additional HIV/AIDS cases should have been established monthly between January 2020 and August 2022 if COVID-19 hadn’t occurred in December 2019.To be specific,the results are listed below:(1)According to results from Pearson correlation analysis,the monthly reported HIV/AIDS cases were inversely correlated with monthly reported COVID-19 cases(r =-0.423,P =0.016),wich indicated the potential correlation between COVID-19 and HIV.(2)The HIV/AIDS monthly reported cases were inversely and significantly associated with the enforcement of stricter lockdown and COVID-19 related polices(Coefficient for Stringency Index from Ox CGRT =-231.24,95%CI:-383.17,-79.32),and we did not find the association between economic support polices and HIV/AIDS monthly reported cases(Coefficient for Economic Support Index from Ox CGRT = 124.27,95%CI:-309.84,558.38).(3)The absolute percentage errors(APEs)of the SARIMA intervention model for prediction of HIV/AIDS monthly cases from January 2022 to August 2022 were-2.99,5.08,-13.64,-34.04,-2.76,-1.52,-1.37 and-2.47 respectively,indicating good accuracy.(4)The results of counterfactual model indicated that additional 1,314 HIV/AIDS cases should have been established monthly between January 2020 and August 2022 if COVID-19 hadn’t occurred in December2019.And the mean of expected series generated by the counterfactual model was significantly higher than actual series(t =-4.143,P < 0.001).ConclusionThe AHTS has brought conveniences for service providers and recipients and has potential in expanging the coverage of HIV testing,and series of challenges still existed in the implementation of this service.Utilizing online platform to provide AHTS may induce concerns about information security among MSM and limite the usage of AHTS among elderly MSM.Besides,the implementation of AHTS didn’t increase the number of active tests in MSM from Shijiazhuang,and the enforcement of COVID-19 control polices was associated with the decline of monthly reported number of active tests in MSM from Shijiazhuang,indicating that the enforcement of COVID-19 control polices could influence the implementation of AHTS.Furthermore,the enforcement of COVID-19 control polices was also associated with the decrease of monthly reported number of HIV cases.And the monthly reported number of HIV cases from January2020 to August 2022 could increase by 1,314 if COVID-19 pandemic had not occurred in 2019.In order to fully utilize the advantages of AHTS,series of measures are needed to be taken in the future.Introducing HIV self-testing services into online system could be efficient in ensuring HIV testing services during COVID-19.In addition,when facing the public health emergency in the future,conducting HIV-related health education and psychological services through online media,ensuring the availability of health resources through HIV self-testing as well as increasing the acceptability of HIV testing among MSM are important to maintain the coverage of HIV testing under the public health emergency.Additionally,medical institutions need to enroll more health prefessionals in order to avoid insuffient human resources when facing public health emergencies. |
PDF Full Text Request