全部 标题 作者
关键词 摘要

Will an Unsupervised Self-Testing Strategy Be Feasible to Operationalize in Canada? Results from a Pilot Study in Students of a Large Canadian University

DOI: 10.1155/2014/747619

Full-Text   Cite this paper   Add to My Lib


Background. A convenient, private, and accessible HIV self-testing strategy stands to complement facility-based conventional testing. Over-the-counter oral HIV self-tests are approved and available in the United States, but not yet in Canada. Canadian data on self-testing is nonexistent. We investigated the feasibility of offering an unsupervised self-testing strategy to Canadian students. Methods. Between September 2011 and May 2012, we recruited 145 students from a student health clinic of a large Canadian university. Feasibility of operationalization (i.e., self-test conduct, acceptability, convenience, and willingness to pay) was evaluated. Self-test conduct was computed with agreement between the self-test performed by the student and the test repeated by a healthcare professional. Other metrics were measured on a survey. Results. Participants were young (median age: 22 years), unmarried (97%), and 47% were out of province or international students. Approximately 52% self-reported a history of unprotected casual sex and sex with multiple partners. Self-test conduct agreement was high (100%), so were acceptability (81%), convenience (99%), and willingness to pay (74%) for self-tests. Concerns included accuracy of self-tests and availability of expedited linkages. Conclusion. An unsupervised self-testing strategy was found to be feasible in Canadian students. Findings call for studies in at-risk populations to inform Canadian policy. 1. Introduction At the end of 2008, an estimated 65,000 Canadians were living with HIV, an increase of 14% since 2005 [1]. About 2,300 to 4,300 new HIV infections occurred in 2008 alone. Despite the availability of facility-based HIV testing and counselling [2], approximately 26% of all positive Canadians remain unaware of their HIV serostatus [1]. Systemic and social barriers, such as stigma, perceived discrimination, and the fear of social visibility and lack of confidentiality have long deterred uptake of conventional facility-based testing. In addition, fear of the test result and the belief that they are not at risk can also prevent some individuals from accessing testing. Furthermore, an increased anxiety associated with long wait times to receive test results and loss of work days associated with getting an HIV test have further impeded the uptake of facility-based HIV testing [3–9]. Conventional testing at a healthcare facility in Canada can be (a) nominal (i.e., the name of the person being tested appears on test forms, results, and medical records), (b) nonnominal (i.e., the test is ordered using a code, but


[1]  Public Health Agency of Canada, HIV/AIDS Epi Updates, Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2010.
[2]  B. M. Branson, H. H. Handsfield, M. A. Lampe et al., “Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings,” Morbidity and Mortality Weekly Report: Recommendations and Reports, vol. 55, no. 14, pp. 1–17, 2006.
[3]  F. Burns, S. G. Edwards, J. Woods et al., “Acceptability and feasibility of universal offer of rapid point of care testing for HIV in an acute admissions unit: results of the RAPID project,” PLoS ONE, vol. 7, no. 4, Article ID e35212, 2012.
[4]  N. P. Pai, R. Barick, J. P. Tulsky et al., “Impact of round-the-clock, rapid oral fluid HIV testing of women in labor in rural India,” PLoS Medicine, vol. 5, no. 5, article e92, 2008.
[5]  N. P. Pai, R. Joshi, S. Dogra et al., “Evaluation of diagnostic accuracy, feasibility and client preference for rapid oral fluid-based diagnosis of HIV infection in rural India,” PLoS ONE, vol. 2, no. 4, article e367, 2007.
[6]  A. Prost, C. J. Griffiths, J. Anderson, D. Wight, and G. J. Hart, “Feasibility and acceptability of offering rapid HIV tests to patients registering with primary care in London (UK): a pilot study,” Sexually Transmitted Infections, vol. 85, no. 5, pp. 326–329, 2009.
[7]  F. Spielberg, B. M. Branson, G. M. Goldbaum et al., “Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men,” Journal of Acquired Immune Deficiency Syndromes, vol. 32, no. 3, pp. 318–327, 2003.
[8]  F. Spielberg, B. M. Branson, G. M. Goldbaum et al., “Choosing HIV counseling and testing strategies for outreach settings: a randomized trial,” Journal of Acquired Immune Deficiency Syndromes, vol. 38, no. 3, pp. 348–355, 2005.
[9]  F. Spielberg, A. Kurth, P. M. Gorbach, and G. Goldbaum, “Moving from apprehension to action: HIV counseling and testing preferences in three at-risk populations,” AIDS Education and Prevention, vol. 13, no. 6, pp. 524–540, 2001.
[10]  U. S. Food and Drug Administration, Approval Letter, OraQuick In-Home HIV Test, 2012, http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/ucm310592.htm.
[11]  Canadian AIDS Society, Rapid HIV Testing in Canada, http://www.cdnaids.ca/rapidhivtestingincanada.
[12]  S. Campbell and R. Klein, “Home testing to detect human immunodeficiency virus: boon or bane?” Journal of Clinical Microbiology, vol. 44, no. 10, pp. 3473–3476, 2006.
[13]  A. A. Wright and I. T. Katz, “Home testing for HIV,” The New England Journal of Medicine, vol. 354, no. 5, pp. 437–440, 2006.
[14]  B. Huff, “FDA hearing on home HIV testing,” GMHC Treatment Issues, vol. 19, no. 12, article 9, 2005.
[15]  M. J. Belza, M. E. Rosales-Statkus, J. Hoyos et al., “Supervised blood-based self-sample collection and rapid test performance: a valuable alternative to the use of saliva by HIV testing programmes with no medical or nursing staff,” Sexually Transmitted Infections, vol. 88, no. 3, pp. 218–221, 2012.
[16]  A. Carballo-Dieguez, T. Frasca, C. Dolezal, and I. Balan, “Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners?” Journal of Sex Research, vol. 49, no. 4, pp. 379–387, 2012.
[17]  A. T. Choko, N. Desmond, E. L. Webb et al., “The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: a cross-sectional feasibility study in Blantyre, Malawi,” PLoS Medicine, vol. 8, no. 10, Article ID e1001102, 2011.
[18]  C. A. Gaydos, Y. H. Hsieh, L. Harvey et al., “Will patients “opt in” to perform their own rapid HIV test in the emergency department?” Annals of Emergency Medicine, vol. 58, no. 1, supplement 1, pp. S74–S78, 2011.
[19]  “Acceptability and ease of use of home self-testing for HIV among MSM,” in Proceedings of the 19th Conference on Retroviruses and Opportunistic Infections, D. Katz, M. Golden, J. Hughes, C. Farquhar, and J. Stekler, Eds., Seattle, Wash, USA, 2012.
[20]  V. J. Lee, S. C. Tan, A. Earnest, P. S. Seong, H. H. Tan, and Y. S. Leo, “User acceptability and feasibility of self-testing with HIV rapid tests,” Journal of Acquired Immune Deficiency Syndromes, vol. 45, no. 4, pp. 449–453, 2007.
[21]  OraSure Technologies, Final Advisory Committee Briefing Materials: Available for Public Release, OraQuick in-Home HIV Test, Food and Drug Administration: Blood Products Advisory Committee, Washington, DC, USA, 2012.
[22]  N. P. Pai, J. Sharma, S. Shivkumar et al., “Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review,” PLoS Medicine, vol. 10, no. 4, Article ID e1001414, 2013.
[23]  K. M. Jackson and W. M. K. Trochim, “Concept mapping as an alternative approach for the analysis of open-ended survey responses,” Organizational Research Methods, vol. 5, no. 4, pp. 307–336, 2002.
[24]  F. ten Kleij and P. A. D. Musters, “Text analysis of open-ended survey responses: a complementary method to preference mapping,” Food Quality and Preference, vol. 14, no. 1, pp. 43–52, 2003.
[25]  G. W. Ryan and H. R. Bernard, “Techniques to identify themes,” Field Methods, vol. 15, no. 1, pp. 85–109, 2003.
[26]  N. P. Pai, B. Balram, S. Shivkumar et al., “Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis,” The Lancet Infectious Diseases, vol. 12, no. 5, pp. 373–380, 2012.
[27]  R. P. Walensky and A. D. Paltiel, “Rapid HIV testing at home: does it solve a problem or create one?” Annals of Internal Medicine, vol. 145, no. 6, pp. 459–462, 2006.
[28]  O. T. Ng, A. L. Chow, V. J. Lee et al., “Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test,” PLoS ONE, vol. 7, no. 9, Article ID e45168, 2012.
[29]  “Convenient, voluntary and confidential: can supervised self-testing improve on current best practices for HIV testing and counseling in Malawi?” in Proceedings of the 18th Conference on Retroviruses and Opportunistic Infections, K. Chavula, N. Desmond, A. T. Choko, et al., Eds., Boston, Mass, USA, 2011.
[30]  R. A. Krueger, Developing Questions for Focus Groups, Sage, Thousand Oaks, Calif, USA, 1997.
[31]  J. G. Geer, “Do open-ended questions measure “salient” issues?” Public Opinion Quarterly, vol. 55, no. 3, pp. 360–370, 1991.
[32]  N. L. Sproull, Handbook of Research Methods: A Guide for Practitioners and Students in the Social Sciences, Scarecrow Press, Lanham, Md, USA, 2nd edition, 1988.


comments powered by Disqus