Effect of Optional Home Initiation of HIV Care Following HIV Self-testing on Antiretroviral Therapy Initiation Among Adults in Malawi A Randomized Clinical Trial
Effect of Optional Home Initiation of HIV Care Following HIV Self-testing on Antiretroviral Therapy Initiation Among Adults in Malawi A Randomized Clinical Trial
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DOI：
10.1001/jama.2014.6493
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发表时间：
2014-07-23
影响因子：
120.7
通讯作者：
Corbett, Elizabeth L.
中科院分区：
文献类型：
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作者：
MacPherson, Peter;Lalloo, David G.;Corbett, Elizabeth L.
目的调查在HIV自我检测后提供可选的家庭启动HIV治疗是否可能增加对ART启动的需求。设计、设置和参与者于2012年1月30日至11月5日在马拉维布兰太尔进行随机试验，使用14个社区卫生工作者集聚地区的限制性1.1随机化。参与者都是成年(16岁)居民(n=16660)，他们通过居民志愿者获得了家庭艾滋病毒自我检测的机会。这是分配给父母试验的HIV自测组的第二阶段随机分组。干预分组被随机分配到基于设施的护理或可选的家庭。对报告艾滋病毒自检结果呈阳性的参与者开始艾滋病毒护理(如果符合条件，包括2周的抗逆转录病毒治疗)。MAIN结果和衡量预先计划的主要结果组间比较，在艾滋病毒自检可用的前6个月内启动抗逆转录病毒治疗的所有成年居民的比例。次要结果是接受HIV自我检测，报告HIV自我检测阳性结果，以及6个月后ART的丢失率。结果家庭组成人发起抗逆转录病毒治疗的比例(181/8194，2.2%)显著高于设施组(63/8466，0.7%；风险比[RR]，2.94，95%CI，2.10~4.12；P<；.001)。家庭(5287/8194，64.9%)和设施组(4433/8466，52.7%；RR，1.23；95%CI，0.96-1.58；P=.10)对HIV自我检测的摄取率都很高。家庭组报告HIV自我检测阳性的成年人明显多于设施组(490/8194[6.0%]vs设施组，278/8466[3.3%]；RR，1.86；95%CI，1.16-2.97；P=0.006)。6个月后，家庭组和设施组181名ART启动者中的52名(28.7%)和63名ART启动者中的15名(23.8%)失去了ART(调整后的发病率比，1.18；95%CI，0.62-2.25，P=.57)。结论与提供HIV自我检测的马拉维成年人相比，可选的家庭启动护理导致启动ART的成年人比例显著增加。
IMPORTANCE Self-testing for HIV infection may contribute to early diagnosis of without necessarily increasing antiretroviral therapy (ART) initiation.OBJECTIVE To investigate whether offering optional home initiation of HIV care after HIV self-testing might increase demand for ART initiation, compared with HIV self-testing accompanied by facility-based services only.DESIGN, SETTING, AND PARTICIPANTS Cluster randomized trial conducted in Blantyre, Malawi, between January 30 and November 5, 2012, using restricted 1.1 randomization of 14 community health worker catchment areas. Participants were all adult (16 years) residents (n = 16 660) who received access to home HIV self-testing through resident volunteers. This was a second-stage randomization of clusters allocated to the HIV self-testing group of a parent trial.INTERVENTIONS Clusters were randomly allocated to facility-based care or optional home.. initiation of HIV care (including 2 weeks of ART if eligible) for participants reporting positive HIV self-test results.MAIN OUTCOMES AND MEASURES The PrePlanned Primary outcome compared between groups the proportion of all adult residents who initiated ART within the first 6 months of HIV self-testing availability. Secondary outcomes were uptake of HIV self-testing, reporting of positive HIV self-test results, and rates of loss from ART at 6 months.RESULTS A significantly greater proportion of adults in the home group initiated ART (181/8194, 2.2%) compared with the facility group (63/8466, 0.7%; risk ratio [RR], 2.94, 95% Cl, 2.10-4.12; P < .001). Uptake of HIV self-testing was high in both the home (5287/8194, 64.9%) and facility groups (4433/8466, 52.7%; RR, 1.23; 95% Cl, 0.96-1.58; P = .10). Significantly more adults reported positive HIV self-test results in the home group (490/8194 [6.0%] vs the facility group, 278/8466 [3.3%]; RR, 1.86; 95% Cl, 1.16-2.97; P = .006). After 6 months, 52 of 181 ART initiators (28.7%) and 15 of 63 ART initiators (23.8%) in the home and facility groups, respectively, were lost from ART (adjusted incidence rate ratio, 1.18; 95% Cl, 0.62-2.25, P = .57).CONCLUSIONS AND RELEVANCE Among Malawian adults offered HIV self-testing, optional home initiation of care compared with standard HIV care resulted in a significant increase in the proportion of adults initiating ART.