Cohort Study On The Effect Of HIV Self-testing With Internet Intervention On Men Who Have With Men In Nanjing

Backgrouds and ObjectivesMen who have sex with men is the main route of homosexual transmission among men and men,and it is also a high-risk group of HIV infection.According to 2017 global HIV statistics,there are still nearly 1/4 people in the world who do not know what they are infected with,and about 9.4 million people who do not know that they are infected with HIV.HIV self-testing method is simple and easy to operate,privacy protection,applicable to all kinds of people,and can go deep into the hard-to-reach groups,such as MSM,has a good role in expanding the detection surface.At the same time,the Internet has become an important way for MSM to obtain HIV-related knowledge and detect information.Researchers can also use the Internet to investigate and intervene in AIDS-related risk behaviors.In this study,the Internet technology was applied to the recruitment and follow-up of the investigation,and the relevant information was collected through the network questionnaire,and the self-test kit was distributed through the network appointment approach.Through this prospective cohort study,we can understand the influence of HIV self-testing kit on high-risk sexual behavior in MSM population.Based on the content and information of field epidemiological investigation,the factors related to HIV self-testing and the specific situation of distribution and use of kits in MSM population in Nanjing at the present stage were analyzed.For the targeted development of HIV testing services to provide theoretical guidance and advice.MethodsThe subjects of this study were 400 HIV negative MSM people who lived in Nanjing,Jiangsu Province,aged between 18 and 45 years old and had anal or oral sex in the last year.From May 13,2017 to June 19,2018,the survey was conducted at the Health Counseling Center of Jiangsu Provincial Center for Disease Control and Prevention.The researchers randomly divided MSM eligible for inclusion,conducted a baseline survey and a follow-up survey every three months.The questionnaire was answered by electronic questionnaire scan code.The contents of the baseline questionnaire mainly included: socio-demographic characteristics,HIV detection history,behavioral characteristic information,HIV discrimination scale,HIV test belief scale and so on.The contents of the follow-up questionnaire in the control group mainly included: in the past three months,my HIV test,sexual partner test,infection status disclosure,number of sexual partners,sexual behavior,high-risk sexual behavior and so on;The contents of follow-up questionnaire mainly included: in the past three months,the detection of HIV,the use and distribution of kits,the use of sexual partners,the number of sexual partners,sexual behavior,high-risk sexual behavior and so on.SPSS 20.0 statistical software is used for data collation and analysis.The measurement data were described by indicators such as utilization rate,composition ratio and so on.Descriptive analysis mainly includes personal basic information,sexual behavior and HIV detection.According to the frequency of variable theory,χ 2 test or Fisher exact probability method were used to compare the differences of HIV self-testing among different groups.The meaningful variables of univariate analysis were analyzed by logistic regression model,and the ratio(Odd ratio,OR)and 95% confidence interval were calculated.According to the professional knowledge,some variables are selected as the possible confounding factors to introduce the regression equation.The OR value was calculated to determine whether there was a difference between Internet HIV self-testing intervention and high-risk sexual behavior.The use and distribution of HIV self-testing kits in the intervention group were tested by Cochran-Armitage trend test to determine whether there was a linear relationship.All the above tests are bilateral tests,and the test level is defined as α = 0.05.Results1.The total of 400 eligible MSM were enrolled in the study.The median age is 27 years(the interquartile spacing is 23-32 years),the youngest is 18 years,the maximum is 46 years,the degree of culture is mainly undergraduate,accounting for 51.5%(206/400),graduate degree or above is 16.5%(66/400);84%(336/400)is in single state;the full-time job accounts for 73.8%(295/400);the average monthly income is 47.3%(189/400);69.8%(279/400)of self-identity are homosexuals;62.8%(251/400)are happy to tell others about their sexual orientation.2.Baseline data analysis showed that the culture level was low(OR=0.293,95%CI: 0.119-0.725),and the last test time was greater than one year or never detected(OR=0.124,95%CI: 0.063-0.244)was an obstacle to HIV self-testing;The monthly average income was high(OR = 3.431,95%CI: 1.418-8.304),and frequent HIV detection(OR=1.823,95%CI: 1.102-3.015)was the promoting factor of HIV self-testing.3.There was no significant difference between the intervention group and the control group at baseline.After 9 months of follow-up,the changes of high-risk sexual behavior between the intervention group and the control group before and after follow-up were compared.In the intervention group,the OR of MSM to high risk sexual behavior in insertive anal sex was 0.477(95%CI: 0.259-0.880)compared with that before follow-up.The OR of high risk sexual behavior in receptive anal sex was 0.492(95%CI: 0.280-0.864),which were statistically significant.In the control group,there was no significant difference in the occurrence of high-risk sexual behavior between insertive anal sex and receptive anal sex after follow-up.4.The analysis of the follow-up data of HIV self-testing in the intervention group showed that there was a linear relationship between the number of HIV self-testing kits(≥ 3)and the error of HIV use and the intervention time(P< 0.05).That is to say,with the prolongation of intervention time,the number of HIV self-testing kits increased gradually,and the number of people who found operation errors was less and less.5.By comparing the data of HIV self-test kits distributed to different sexual partners in the intervention group,it can be found that,on the whole,the proportion of kits distributed to fixed partners is higher than that of non-fixed partners.The proportion of fixed partners distributed to fixed partners increased gradually with the passage of time(P< 0.05).The number of kits distributed to fixed partners and non-fixed partners was mainly 1-2,but the proportion of fixed partners distributed ≥ 3 kits increased(P< 0.05).Compared with fixed partners,the proportion of providing HIV detection standard operating video to non-fixed partners was higher,and the proportion of providing fixed partners with operating standard video showed a downward trend(P< 0.05).Conclusions1.The educational level is technical school or junior college,more than one year has not detected or never tested is the hindrance factor of HIV self-detection behavior,the monthly average income is high,the past HIV detection frequency is the promotion factor of HIV self-detection.2.HIV self-testing intervention with Internet can reduce the occurrence of high-risk sexual behavior in MSM population,improve the awareness of health risk of this kind of population,and help to reduce the risk of HIV infection.3.The self-use of HIV self-test reagent by MSM is feasible.HIV self-detection reagent can be recommended to sexual companion by self-social network,and the detection population can be expanded through social relations,so as to promote HIV detection and positive detection.