HIV Diagnosis, Linkage to HIV Care, and HIV Risk Behaviors Among Newly Diagnosed HIV-Positive Female Sex Workers in Kigali, Rwanda
HIV Diagnosis, Linkage to HIV Care, and HIV Risk Behaviors Among Newly Diagnosed HIV-Positive Female Sex Workers in Kigali, Rwanda
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DOI：
10.1097/qai.0b013e3182170fd3
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发表时间：
2011-08-01
影响因子：
3.6
通讯作者：
Nash, Denis
中科院分区：
文献类型：
--
作者：
Braunstein, Sarah L.;Umulisa, Marie-Michele;Nash, Denis
目的：评估卢旺达新诊断出艾滋病毒的女性性工作者 (FSW) 与护理的联系、性行为变化和社会心理经历。方法：2007/2008 年期间对血清状态未知的女性性工作者 (FSW) (n = 800) 进行了艾滋病毒筛查。 HIV 检测呈阳性的女性 (n = 192) 被转介至护理机构，并要求在诊断后 12-36 个月返回进行面谈和实验室检测。 141 名女性 (73%) 返回进行诊断后访视。结果：诊断时的中位 CD4 计数为每微升 460 个细胞 [四分位数范围 (IQR)：308-628]，根据国家 CD4 标准，32% 的女性符合抗逆转录病毒治疗 (ART) 条件（中位 CD4：235，IQR：152303）。诊断后，92% 的女性报告称已向朋友或亲戚透露了自己的艾滋病毒感染状况，85% 的女性报告称已参加艾滋病毒护理（诊断后 30 天中位数，IQR：7-360），其中 89% 的女性符合 ART 资格。在符合 ART 资格的接受护理的女性中，87% 已开始 ART，随访中 CD4 计数中位数为每微升 354 个细胞（IQR：213-456）。未开始 ART 的女性 6 个月内 CD4 计数变化为每微升 214 个细胞（IQR：241 至 13）。四分之三的女性报告诊断后性危险行为减少，只有 64% 的女性继续被认定为 FSW。然而，53% 的受访者表示上个月仅“有时”使用安全套。结论：在这组卢旺达 FSW 中，与护理的及时联系和 ART 的采用率很高。然而，在入院后，危险的性行为仍然很常见。 HIV 阳性 FSW 是一个重要且容易接受的群体，有针对性地努力增加 HIV 诊断以及与护理/治疗的联系。一旦接受护理，就必须加强和持续进行艾滋病毒预防教育。
Objective: To evaluate linkage-to-care, sexual behavior change, and psychosocial experiences among newly HIV-diagnosed female sex workers (FSWs) in Rwanda.Methods: FSWs (n = 800) with unknown serostatus were screened for HIV during 2007/2008. Women testing HIV positive (n = 192) were referred to care and asked to return for interviews and laboratory testing 12-36 months postdiagnosis. One hundred fourty-one women (73%) returned for the postdiagnosis visit.Results: Median CD4 count at diagnosis was 460 cells per microliter [interquartile range (IQR): 308-628], with 32% eligible for antiretroviral therapy (ART) per national CD4 criteria (median CD4: 235, IQR: 152303). Postdiagnosis, 92% of women reported having disclosed their HIV status to a friend or relative, 85% reported having enrolled in HIV care (median 30 days after diagnosis, IQR: 7-360), including 89% among ART-eligible women. Among ART-eligible women in care, 87% had initiated ART, with a median follow-up CD4 count of 354 cells per microliter (IQR: 213-456). Women who did not initiate ART experienced a 6-month CD4 count change of 214 cells per microliter (IQR: 241 to 13). Three-quarters of women reported reduced sexual risk behavior postdiagnosis, with only 64% continuing to identify as FSWs. However, 53% reported past month condom use only "sometimes."Conclusions: Timely linkage to care and ART uptake were high in this group of Rwandan FSWs. However, risky sexual behaviors remained common after enrollment in care. HIV-positive FSWs are an important and receptive group for targeted efforts to increase HIV diagnosis and linkage to care/treatment. Once in care, intensified and sustained HIV prevention education is necessary.