Uptake of and factors associated with testing for sexually transmitted infections in community-based settings among youth in Zimbabwe: a mixed-methods study.
Uptake of and factors associated with testing for sexually transmitted infections in community-based settings among youth in Zimbabwe: a mixed-methods study.
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津巴布韦青年在社区环境中接受性传播感染检测的情况及其相关因素：一项混合方法研究。
DOI：
10.1016/s2352-4642(20)30335-7
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Ferrand RA
中科院分区：
文献类型：
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作者：
Martin K;Olaru ID;Buwu N;Bandason T;Marks M;Dauya E;Muzangwa J;Mabey D;Dziva Chikwari C;Francis SC;Tembo M;Mavodza C;Simms V;Mackworth-Young CRS;Machiha A;Kranzer K;Ferrand RA
在撒哈拉以南非洲，青年中性传播感染的流行率很高。我们调查了津巴布韦社区青年对沙眼衣原体(衣原体)和淋病奈瑟菌(淋病)感染检测的接受率和流行率，并探讨了检测的促进者和障碍。这项研究是在一项以社区为基础为16-24岁青年提供综合艾滋病毒以及性健康和生殖健康服务的随机分组试验中进行的。在津巴布韦哈拉雷的四个干预组中，使用Xpert CT/NG测试通过尿样进行衣原体和淋病检测。在257名参与者(n=257)中，使用分层多变量Logistic回归研究了与测试摄取相关的因素。对一个单独的有目的地选择的样本(n=26)进行了深入访谈，探讨了科技创新测试和伙伴通知的促进者和障碍，并使用专题分析进行了分析。在2019年6月1日至2020年1月31日期间，4440名参与者(78.2%的女性，21.8%的男性)参加了6200次活动，平均年龄为20.3岁(智商17.9-22.8)。1478名参与者进行了1501次测试，其中248次测试呈阳性，1253次测试衣原体和/或淋病均为阴性。STI试验摄取率为33.3%(95%可信区间31.9-34.7%)，从2019年6月的11.7%上升到2020年1月的37.1%。衣原体和/或淋病的患病率为16.5%(95%可信区间为14.7-18.5；1501人中有248人)，只有7人(3%)出现症状。总收率4.0%(95%可信区间3·5~4·5；6200个样品248个)。服药与有症状相关(调整优势比[OR]14·8，95%CI 1·66~132·07)，与单身(调整OR 0·33，95%CI 0·13~0·84)或有男朋友或女朋友(调整OR 0·19，95%CI 0·087~0·43)负相关；与在校学生相比(调整OR 0·26，95%CI 0·10-0·68)。感知的风险和性传播感染的症状是检测的动机，而错误信息、预期的污名和对保密的担忧是障碍。衣原体和/或淋病在年轻人中的流行率很高，但只有少数人有症状。因此，如果不能获得性传播感染检测，大多数感染仍将得不到治疗。提供教育、咨询和保密对于提高性传播感染检测的接受度和可接受性至关重要。惠康信托公司。
The prevalence of sexually transmitted infections (STIs) among youth is high in sub-Saharan Africa. We investigated the uptake of testing for and prevalence of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhoea) infections among youth in community-based settings in Zimbabwe, and explored the facilitators and barriers to testing. This study was nested within a cluster randomised trial of community-based delivery of integrated HIV and sexual and reproductive health services for youth aged 16–24 years. Chlamydia and gonorrhoea testing via urine samples using the Xpert CT/NG test was offered in the four intervention clusters in Harare, Zimbabwe. Factors associated with testing uptake were investigated in a subset of participants (n=257) using hierarchical multivariate logistic regression. In-depth interviews with a separate purposively selected sample (n=26) explored facilitators and barriers to STI testing and partner notification and were analysed using thematic analysis. Between June 1, 2019, and Jan 31, 2020, there were 6200 attendances by 4440 participants (78·2% women, 21·8% men) median age 20·3 (IQR 17·9–22·8) years. 1478 participants had 1501 tests done, and 248 tests were positive and 1253 tests were negative for chlamydia or gonorrhoea, or both. STI test uptake was 33·3% (95% CI 31·9–34·7), increasing from 11·7% in June, 2019, to 37·1% in January, 2020. The prevalence of chlamydia or gonorrhoea, or both, was 16·5% (95% CI 14·7–18·5; 248 of 1501), with only seven participants (3%) showing symptoms. The overall yield of testing was 4·0% (95% CI 3·5–4·5; 248 of 6200). Uptake was associated with having symptoms (adjusted odds ratio [OR] 14·8, 95% CI 1·66–132·07) and negatively associated with being single (adjusted OR 0·33, 95% CI 0·13–0·84) or having a boyfriend or girlfriend (adjusted OR 0·19, 95% CI 0·087–0·43) compared with being married, and being a student compared with being employed (adjusted OR 0·26, 95% CI 0·10–0·68). Perceived risk and symptoms of STIs were motivators for testing whereas misinformation, anticipated stigma, and concern about confidentiality were barriers. The prevalence of chlamydia or gonorrhoea, or both, was high among youth but only a minority were symptomatic. Therefore most infections would remain untreated without access to STI testing. Provision of education, counselling, and confidentiality are essential to improve uptake and acceptability of STI testing. Wellcome Trust.