Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya.
Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya.
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DOI：
10.1177/0956462415568982
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发表时间：
2016-01
影响因子：
1.4
通讯作者：
Bock N
中科院分区：
文献类型：
--
作者：
Djomand G;Gao H;Singa B;Hornston S;Bennett E;Odek J;McClelland RS;John-Stewart G;Bock N
在大多数区域，控制生殖器感染仍然具有挑战性。尽管世界卫生组织（世卫组织）倡导综合征病例管理，但关于综合征方法的数据有限，特别是在艾滋病毒护理环境中。这项研究比较了肯尼亚妇女艾滋病毒护理中的综合征方法和实验室诊断。一个流动小组访问了肯尼亚的39个大型艾滋病毒护理项目，并采用按人口比例抽样的方法招募了参与者。参与者提供了行为和临床数据，包括生殖器和血液样本供实验室检测。在1063名妇女中，68.4%的人接受了10年的抗逆转录病毒治疗；使用复方新诺明预防的占58.9%；51% CD4+ t淋巴细胞< 350细胞/mL。大多数妇女（63.1%）报告至少有一种生殖器症状。63%的女性有临床症状；30.8%有病原学诊断。细菌性阴道病（17.4%）、阴道念珠菌病（10.6%）和滴虫病（10.5%）是最常见的诊断。以实验室诊断为金标准，阴道分泌物证候诊断的敏感性和阳性预测值分别为47.6%和52.7%，存在大量的过度治疗。系统体检对生殖器溃疡疾病的阳性预测值提高了9.3%。在肯尼亚参加艾滋病毒护理项目的妇女阴道感染率很高。综合征诊断不能很好地预测这些感染。
Control of genital infections remains challenging in most regions. Despite advocacy by the World Health Organization (WHO) for syndromic case management, there are limited data on the syndromic approach, especially in HIV care settings. This study compared the syndromic approach against laboratory diagnosis among women in HIV care in Kenya. A mobile team visited 39 large HIV care programs in Kenya and enrolled participants using population-proportionate sampling. Participants provided behavioral and clinical data with genital and blood specimens for lab testing. Among 1,063 women, 68.4% had been on antiretroviral therapy >1 year; 58.9% were using cotrimoxazole prophylaxis; 51 % had CD4+T-lymphocytes < 350 cells/mL. Most women (63.1%) reported at least one genital symptom. Clinical signs were found in 63% of women; and 30.8% had an etiological diagnosis. Bacterial vaginosis (17.4%), vaginal candidiasis (10.6%) and trichomoniasis (10.5%) were the most common diagnoses. Using laboratory diagnoses as gold standard, sensitivity and positive predictive value of the syndromic diagnosis for vaginal discharge were 47.6% and 52.7%, respectively, indicating a substantial amount of overtreatment. A systematic physical examination increased by 9.3% the positive predictive value for genital ulcer disease. Women attending HIV care programs in Kenya have high rates of vaginal infections. Syndromic diagnosis was a poor predictor of those infections.