摘要：We examined the potential for increasing the reach of HIV testing to African American youths through the dissemination of oral-HIV testing. From 2012 through 2013 we examined the perceptions of alternatives to pharmacy dissemination of SITs in African American youths (5 focus groups) and service providers (4 focus groups), and conducted an ethnographic study of pharmacies (n = 10). Participants perceived significant advantages to delivering SITs through community health and services for adolescents (e.g., increased confidentiality, reduced stigma) over pharmacy dissemination. Given proper attention to fit, SIT dissemination could be facilitated through distribution by health and social service sites, and by improving elements of pharmacy dissemination. HIV testing is a linchpin in the Centers for Disease Control and Prevention Comprehensive HIV Prevention Strategy (CHPS). 1–6 CHPS has a national goal of testing 90% of HIV-positive persons by 2015. 7 In the United States, HIV testing relies heavily on clinic-based testing. 8 However, clinic-based testing poses significant barriers for adolescents and young adults, including inconvenience (time, location, transportation), privacy concerns, and fears of being socially stigmatized. 9–14 In particular, clinic-based testing has limited reach among underserved high-risk populations (e.g., African American adolescents and young adults 15–26 ). Approximately 61% of HIV-positive African American youths do not know their HIV status, 20 creating delays in diagnosis and treatment that, in turn, produce poor prevention and survival outcomes. Self-implemented HIV testing (SIT) addresses these problems by increasing privacy and convenience. 27 Oral method SIT (OraQuick; OraSure Technologies, Bethlehem, PA) is approved in the United States for sale by retail pharmacies ($40+/kit) to those aged 17 years and older. 28,29 Oral SIT requires no special storage, and is preferred over finger stick technology. 27 Oral SITs may provide an important supplement to clinic-based testing. However, purchasing oral SITs requires a verbal request of a pharmacist in a relatively public situation that may be uncomfortable for many youths. Moreover, use of neighborhood pharmacies may heighten embarrassment and social stigma if youths are worried that neighbors may observe their kit purchases. Extending the reach of SITs may require innovative dissemination strategies through nontraditional sites. 5 In this regard, youth-focused, community-based organizations (CBOs) and social or health services may offer greater familiarity, comfort, and privacy from the larger community. We conducted a series of qualitative studies that examined the dissemination of oral SITs with African American adolescents, service providers, and pharmacies.
