| Background: In China,although the HIV/AIDS prevalence is low in recent years,the proportion of HIV infection caused by homosexual transmission has increased significantly.Traditional interventions,such as increasing condom use or promoting facility-based HIV testing,have not effectively reduced the rate of HIV recent infection among men who have sex with men(MSM).Therefore,it is necessary to provide a new preventive measure,that is pre-exposure prophylaxis(PrEP).PrEP has become a hotspot in HIV/AIDS prevention and control research in recent years,and its safety and effectiveness in preventing HIV infection have been confirmed in several studies.Truvada has been approved in several European and American countries,and the local HIV epidemic has been well controlled.However,the protecting effect dependends on medication adherence.Once it is not taken on time and accompanied by high-risk behaviors,there may be a possibility of causing secondary drug resistance.In order to avoid this kind of events,PrEP participants are required to take regular and timely HIV testing.Considering that the awareness of HIV testing is insufficient among MSM in China,and the key populations have a high acceptance of HIV self-testing in general,it is proposed to use HIV self-testing kits to increase the HIV testing frequencies among MSM PrEP participants,and to avoid secondary drug resistance that may occur during the PrEP administration.It is also for preliminarily evaluating the application experiences,the feedback rates of self-testing results,and related influencing factors of HIV self-testing in MSM participants.This will provide scientific references for HIV testing services during the promotion of PrEP in China.Methods: The baseline survey of this study was for MSM who had the willingness to accept PrEP and went to the clinic to participate in the screening of the PrEP project.Participants were recruited online and offline by the gay working group at each site.By baseline cross-sectional questionnaire survey,the study obtained the awareness of HIV self-testing,the proportion of lifetime HIVST use,and the willingness to accept HIVST,and compared the social demographic characteristics and sexual behaviors of HIVST users and non-users,and understood the different characteristics between high willingness participants and low willingness participants.The subjects enrolled in this study were MSM who were qualified for PrEP screening and completed the first time,and prospective follow-up of the subjects who had received the self-testing kits.After the research object receives the self-testing kits,the detection time and the test location can be determined according to the situation.The self-test package is equipped with an operation manual.After the self-test is completed,the research object can be immediately uploaded by the mobile phone scanning manual.The results of the examination results are for medical personnel to review and interpret,and at the same time self-filling the behaviors and operational characteristics of the self-inspection.At the first,third,sixth,ninth,and twelfth months of the enrollment,the study subjects were required to return to the clinic to complete the clinical visits,conduct laboratory testings,such as HIV testing and syphilis testing,and collect follow-up questionnaires.Finally,the selftesting kits completed the self-test results and the influencing factors,and truly grasp the actual use,difficulty and problems of the HIV self-testing kits in the MSM group.Results: 1.During the study period(December 20,2018 to February 17,2019),there were134 MSM who had the willingness to receive PrEP and went to the clinic to participate in the baseline screening.The proportion of HIV previously tested was 96.3%(129/134).97.0%(130/134)of the respondents knew/heard of HIV self-testing,and 67.9%(91/134)of the people used self-testing kits in the past year.The factors influencing the use of HIV selftesting kits in the past year include: first sexual age ≤20 years(vs.> 20 years old,a OR =4.2,95% CI: 1.8-9.6,P = 0.001),condom use for most of the time in the past three months(vs.for a small amount of time,a OR=2.3,95% CI: 1.0-4.9,P=0.039),used Rush in the past three months(vs.not used,a OR=2.5,95% CI: 1.2-5.6,P=0.021),taking PEP in the past six months(vs.not taken,a OR=12.0,95% CI: 1.5-95.6,P=0.019),HIV test ≥2 times per year(vs.HIV test <2 times per year,a OR=9.2,95% CI: 3.2-26.9,P<0.001),HIV testing period usually less than three months(vs.more than one year,a OR=6.6,95% CI :1.1-40.4,P=0.040),usually pay attention to HIV prevention and control information(vs.occasionally or never pay attention to this,a OR=3.8,95% CI: 1.7-8.2,P=0.001),share HIV prevention and control information with others(vs.never shared,a OR=4.3,95% CI:1.5-12.5,P=0.008).2.After introduction the whole study,96.3%(129/134)were willing to accept free HIV self-testing kits,grouped according to the degree of willingness to accept,and divided into groups with higher willingness to accept(n=103)and those who accept less willingness(n=31).Compared with those who are not willing to accept,those with higher willingness had a higher average monthly income(≥6,000 yuan),had a lower proportion of facilitybased HIV testing in the past year,had higher proportions of sexually transmitted diseases and syphilis testing in the past year,and more likely to choose daily PrEP method.3.As of February 17,2019,110 people(56 in Shenyang,15 in Beijing,5 in Shenzhen,and34 in Chongqing)successfully enrolled in the PrEP study.After randomization of selftesting,53(48.2%)were enrolled in self-testing group.A total of 33 self-testing results were collected from four study sites,of which 29 were tested by the subjects,and 4 were tested by peers of subjects.The results were HIV-negative and no syphilis reactive results were found.A total of twentity-two self-test results were reported(42.3%),of which two persons had self-tested three times and three persons had self-tested twice.The living condition is very stable(vs.relatively stable,a OR=12.5,95% CI: 2.3-68.8),and the condom is used for most of the past three months of the baseline(vs.condom use for a small part of time,a OR=0.2,95% CI: 0.1-0.7),fixed male sexual partners in the past three months(vs.no fixed male partner,a OR=12.8,95% CI: 2.9-55.9),used HIV self-test kits in the past year(vs.not used,a OR=6.0,95% CI: 1.1-31.5)was significantly associated with the feedback of self-testing results(P<0.05).According to the data collected by the feedback questionnaires,most of the self-testers completed the test at home.Most of them thought that the self-testing operation was easy,and most of them could complete independently without anyone’s help.Most of them trust the self-testing results and were willing to be honest to tell their peers.And most selftesting activities were performed along with sexual behaviors.Conclusions: 1.MSM populations with the willingness to accept PrEP have a higher proportion of HIV testing,higher HIV testing awareness,higher proportion of lifetime selftesting kits use,and higher frequency in self-testing users.2.The MSM population with the willingness to receive PrEP has a higher willingness to accept HIV self-testing kits during the PrEP medication,and the average monthly income,the proportion of sexually transmitted diseases,and the proportion of patients with higher willingness to accept,compared with those who do not accept the self-testing.The proportion of PrEP daily medications is also higher.3.Particpants who have submitted the self-testing results mostly expressed that the operation was simple,and could be completed independently.This reflects the feasibility of providing self-testing kits as an additional HIV testing service during the PrEP. |
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