Investigation On HIV Testing And Oral Rapid Detection Of Oral Saliva In Beijing

BackgroundWe are facing huge challenge in HIV prevention because of the rapid increase of HIV epidemic among MSM in China. Early detection of HIV infection not only reduces the chance of transmitting the virus to uninfected individuals, but also enables timely treatment and thus reduces AIDS-and non-AIDS-related mortality and morbidity. Therefore, the Chinese government has made massive efforts to increase HIV testing among men who have sex with men (MSM) in recent years, including building HIV voluntary counseling and testing (VCT) clinics to provide free HIV testing, popularizing HIV rapid tests, and reducing HIV-related stigma. Recently, Chinese government has cost massive material and money and scaled up publicity and motivation on promoting HIV testing and counseling. The oral fluid test which is relatively convenient, rapid, and accurate compared with blood-based tests can help improve the rates of HIV testing. To improve rate of HIV testing and awareness of HIV infection, the study investigated changes in HIV testing and associated factors, as well as willingness to use HIV oral fluid test.ObjectiveThe first section1. To explore HIV testing and associated factors among MSM of Beijing in2009,2010and2011.2. To assess the willingness to uptake the oral fluid HIV rapid test and its associated factors, the price they willing to pay and the price elastic coefficient among MSM.MethodsThe first sectionWe conducted3annual respondent-driven sampling (RDS) surveys from2009to2011and we recruited500MSM in each year. Participants completed a computerized structured questionnaire administered by a trained staffs. After completing questionnaires, pre-testing counseling and HIV and Syphilis testing were offered to clients and then HIV test results were returned to participants along with face-to-face post-testing counseling.The second sectionThis cross-sectional study was conducted among MSM at a VCT site at the Chaoyang CDC from July to October2012. The participants were recruited in three ways:advertisements on a website (www.hivolunt.net). calling in people by phone and introduction by gay friends. Data were collected by self-administered questionnaires. After the questionnaires were completed, confidential HIV pre-test counseling and the traditional blood-based HIV rapid test and Syphilis testing were conducted. Finally, interviewers informed the participant of their test results and provided post-test counseling according to the results.ResultsThe first sectionA total of1312participants were screened for the study (500,385and427in2009,2010and2011, respectively) and were included in the analysis. We detected stability in demographics and sexual behaviors(P>0.05).56.4%(740/1312) MSM reported they had participated HIV testing in the past1year. The results of logistic analysis demonstrated that the following factors are associated with HIV testing in the past one year:completed12years or more education(AOR=1.43,95%CI=1.10-1.84); lived in Beijing for3years (AOR=1.55;95%CI=1.23-1.95); knew MSM in Beijing>10(AOR=1.68;95%CI=1.16-2.45); no female sexual partners in past6months (AOR=1.60;95%CI=1.27-2.03); the score of discrimination scale>25(AOR=0.74;95%CI=0.58-0.94).There is a significant increase in HIV testing in the past1year (53.2%,49.1%and66.7%in2009,2010, and2011, respectively, P<0.01). In the context of general increase in the recent HIV testing, the MSM who were≤25years old, minority ethnics, having Beijing residence card, and living in suburb did not experienced increasing trends after analysis by being stratified(P>0.05).Several barriers (unwilling to go to designated HIV testing sites; fear of being seen by friends at testing site; fear health personnel would not keep result private; fear of knowing HIV positive) did not indicate declining trends(P>0.05) and consistently maintained a high level. Furthermore, an increasing trend in MSM reported that "Do not perceive risk for HIV" was a barrier for HIV testing(P<0.05).The second sectionOf262survey participants,85.1%(223/262) reported that they were willing to use the oral fluid HIV rapid test. Independent predictors of willingness to use the oral fluid test were higher education (AOR:2.40,95%CI:1.13-5.10), lack of UAI with male partners in the past1month (AOR:2.38;95%95%CI:1.15-4.95), having taken more than4HIV tests (AOR:3.54;95%CI:1.52-8.28), and having ever heard of the oral fluid HIV rapid test from gay friends or gay organizations (AOR:3.24,95%CI:1.40-7.51).Of14.9%(39/262) unwilling to use the oral fluid rapid HIV test,79.5%(31/39) expressed concerns about accuracy about result of the oral fluid HIV rapid test and17.9%(7/39) reported that they were not familiar with it and did not know how to use such test.2.6%(1/39) is other reasons.85.1%(223/262) participants who reported willingness to use the oral fluid HIV rapid test were asked the cost they willing to pay. The multiple logistic analysis identified that the living in Beijing more than3years (AOR=3.08;95%CI=1.33-7.16), the number of male sexual partners in the past6months more than2(AOR=1.75;95%CI=1.12-2.74), has ever paid for an HIV test (AOR=2.24;95%CI=1.36-3.69), and trusts in the accuracy of the oral fluid HIV rapid test (AOR=1.61;95%CI=1.02-2.54) were associated with higher price willing to pay. The median cost was50(interquartile range:10-90) with a range from0to500. The participants who were willing to pay for the oral fluid test in the range of1～9,10～29,30～49,50～99,100～149,150～199and≥200yuan were53(6.3%),25(11.2%),23(10.3%), 16(7.2%),64(28.7%),57(25.6),4(1.8%),20(9.0%) respectively. When the price decreased from150yuan to100,50and30yuan, the flexibility coefficient of the price were2.71、1.43and1.11, respectively.35.9%MSM chose to do HIV testing with blood-based rapid testing in VCT of hospital.15.7%preferred to test with ELISA in VCT of hospital.15.5%chose to test using oral fluid HIV rapid tests at home.ConclusionAlthough the increasing trends in taking HIV testing among MSM during2009and2011, more attention should be paid to alleviate structural and psychological barriers through providing more convenience and confidentiality of HIV testing circumstance, carrying more flexible testing schedules, reducing the potential psychological barriers of HIV infection, discrimination and stigma, and improving HIV risky perspective. Meanwhile, underserved demographic and geographic sub-populations should be considered.Popularizing HIV rapid tests and improving establishment of VCT clinics in hospital can be content with the demand for HIV testing among MSM. Meanwhile, the suitability of oral fluid rapid testing to promote HIV testing should be further studied.