Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial.
Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial.
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DOI：
10.1016/s2214-109x(14)70032-4
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发表时间：
2014-05
影响因子：
34.3
通讯作者：
Eshleman, Susan H.
中科院分区：
文献类型：
--
作者：
Coates, Thomas J.;Kulich, Michal;Celentano, David D.;Zelaya, Carla E.;Chariyalertsak, Suwat;Chingono, Alfred;Gray, Glenda;Mbwambo, Jessie K. K.;Morin, Stephen F.;Richter, Linda;Sweat, Michael;van Rooyen, Heidi;McGrath, Nuala;Fiamma, Agnes;Laeyendecker, Oliver;Piwowar-Manning, Estelle;Szekeres, Greg;Donnell, Deborah;Eshleman, Susan H.
NIMH Project Accept（HPTN 043）是一项随机分组试验，旨在测试与标准自愿咨询和检测（SVCT）相比，多组分、多层次预防策略（基于社区的自愿咨询和检测[CBVCT]）是否降低了HIV发病率。在南非、坦桑尼亚、津巴布韦和泰国的五个地点招募了48个社区。CBVCT旨在使社区更容易获得检测，通过外联活动吸引社区参与，并提供检测后支持服务。自愿咨询和检测包括在现有设施中建立的标准自愿咨询和检测服务。社区被随机配对到36个月的CBVCT或SVCT。通过对18-32岁社区居民的横断面随机调查，在基线（n= 14，567）和干预后（n= 56，683）收集数据。HIV发病率估计采用横断面多测定算法。由于艾滋病毒流行率低，泰国被排除在发病率分析之外。CBVCT的估计发生率为1.52%，SVCT为1.81%，估计HIV发生率降低13.9%（相对风险[RR]= 0.86; 95%置信区间[CI]= 0.725 - 1.023; p= 0.08）。24岁以上女性的RR= 0.70（95% CI= 0.54 - 0.90; p= 0.009）。CBVCT使总体检测率提高了25%（95% CI=12%-39%; p= 0.0003），男性提高了45%，女性提高了15%。未观察到对性风险行为的总体影响。然而，在HIV感染者中，CBVCT使性伴侣的数量减少了8%（95% CI=1%-15%; p=0.03），多个伴侣的比例减少了30%（95% CI=8%-46%; p=0.01）。在CBVCT社区，有关艾滋病毒检测的社会规范得到了改善。干预措施有效地增加了艾滋病毒检测，特别是在男子中，促进了关于检测的积极社会规范，并减少了艾滋病毒感染者的行为风险。艾滋病毒感染率略有下降。这一干预措施主要侧重于艾滋病毒检测。当前和未来的研究，包括艾滋病毒治疗和病毒抑制策略，应该表明发病率进一步降低。
NIMH Project Accept (HPTN 043) was a cluster-randomized trial that tested whether a multicomponent, multi-level prevention strategy (community-based voluntary counselling and testing [CBVCT]) reduced HIV incidence compared to standard voluntary counselling and testing (SVCT). Forty-eight communities were enrolled at five sites in South Africa, Tanzania, Zimbabwe, and Thailand. CBVCT was designed to make testing more accessible in communities, engage communities through outreach, and provide post-test support services. SVCT comprised standard VCT services established at existing facilities. Communities were randomized in matched pairs to 36 months of CBVCT or SVCT. Data were collected at baseline (n=14,567) and post-intervention (n=56,683) by cross-sectional random surveys of 18–32 year-old community residents. HIV incidence was estimated using a cross-sectional multi-assay algorithm. Thailand was excluded from incidence analyses due to low HIV prevalence. The estimated incidence in the CBVCT was 1.52% vs. 1.81% in the SVCT with an estimated reduction in HIV incidence of 13·9% (relative risk [RR]=0·86; 95% confidence interval [CI]=0·725–1·023; p=0·08). Women older than 24 years had RR=0·70 (95% CI=0·54–0·90; p=0·009). CBVCT increased testing rates by 25% overall (95% CI=12%–39%; p=0·0003), by 45% among men and 15% among women. No overall effect on sexual risk behaviour was observed. However, among HIV-infected participants, CBVCT reduced the number of sexual partners by 8% (95% CI=1%–15%; p=0.03) and the proportion of multiple partnerships by 30% (95% CI=8%-46%; p=0.01). Social norms regarding HIV testing were improved in CBVCT communities. The intervention was effective in increasing HIV testing, particularly among men, promoted positive social norms regarding testing, and reduced behavioural risk among HIV-infected participants. A modest reduction in HIV incidence was observed. This intervention focused primarily on HIV detection. Current and future studies that include strategies for HIV treatment and viral suppression should demonstrate further incidence reductions.