Improving HIV test uptake and case finding with assisted partner notification services.
Improving HIV test uptake and case finding with assisted partner notification services.
复制标题
DOI：
10.1097/qad.0000000000001555
复制
发表时间：
2017-08-24
期刊：
影响因子：
--
通讯作者：
Baggaley R
中科院分区：
文献类型：
--
作者：
Dalal S;Johnson C;Fonner V;Kennedy CE;Siegfried N;Figueroa C;Baggaley R
尽管艾滋病毒检测服务（HTS）的巨大扩展，估计有40%的艾滋病毒感染者仍然没有得到诊断。为了提高HTS的效率，需要新的方法。世卫组织对协助伴侣通知在改善艾滋病毒检测和诊断以及不良事件发生方面的有效性进行了系统审查，以通报规范性指南的制定情况。我们系统地检索了截至2016年6月的5个电子数据库。我们还联系了该领域的专家和研究作者，以获取必要的额外信息。符合条件的研究比较了艾滋病毒伴侣的协助通知服务，被动或没有通知。如果多项研究报告了可比的结局，则使用随机效应模型进行荟萃分析，以产生相对风险（RR）或风险比和95%置信区间（CI）。在识别的1742篇引文中，纳入了4项随机对照试验和6项观察性研究，共计来自8个国家的5150例索引患者。三项单独随机试验的荟萃分析显示，与被动转诊相比，协助伴侣通知服务导致伴侣中HTS摄取增加1.5倍（RR = 1.46; 95%CI：1.22-1.75; I2 = 0%）。 艾滋病毒阳性的合作伙伴的比例是1.5倍，协助合作伙伴通知比被动转诊（RR = 1.47; 95%CI：1.12-1.92; I2 = 0%）。 很少发生暴力或伤害事件。协助伴侣通知改善了对艾滋病毒阳性伴侣的伴侣检测和诊断，几乎没有伤害报告。世卫组织强烈建议将自愿协助的艾滋病毒伴侣通知服务作为全面检测和护理一揽子计划的一部分提供。
Despite the enormous expansion of HIV testing services (HTS), an estimated 40% of people with HIV infection remain undiagnosed. To enhance the efficiency of HTS, new approaches are needed. The WHO conducted a systematic review on the effectiveness of assisted partner notification in improving HIV test uptake and diagnosis, and the occurrence of adverse events, to inform the development of normative guidelines. We systematically searched five electronic databases through June 2016. We also contacted experts in the field and study authors for additional information where needed. Eligible studies compared assisted HIV partner notification services to passive or no notification. Where multiple studies reported comparable outcomes, meta-analysis was conducted using a random-effects model to produce relative risks (RRs) or risk ratios and 95% confidence intervals (CIs). Of 1742 citations identified, four randomized controlled trials and six observational studies totalling 5150 index patients from eight countries were included. Meta-analysis of three individually randomized trials showed that assisted partner notification services resulted in a 1.5-fold increase in HTS uptake among partners compared with passive referral (RR = 1.46; 95% CI: 1.22–1.75; I2 = 0%). The proportion of HIV-positive partners was 1.5 times higher with assisted partner notification than with passive referral (RR = 1.47; 95% CI: 1.12–1.92; I2 = 0%). Few instances of violence or harm occurred. Assisted partner notification improved partner testing and diagnosis of HIV-positive partners, with few reports of harm. WHO strongly recommends voluntary assisted HIV partner notification services to be offered as part of a comprehensive package of testing and care.