Non-enrollment for free community HIV care: findings from a population-based study in Rakai, Uganda
Non-enrollment for free community HIV care: findings from a population-based study in Rakai, Uganda
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DOI：
10.1080/09540121.2010.525614
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发表时间：
2011-01-01
影响因子：
1.7
通讯作者：
Wawer, Maria
中科院分区：
文献类型：
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作者：
Nakigozi, Gertrude;Makumbi, Fredrick;Wawer, Maria
在人口一级更好地了解与艾滋病毒有关的求医行为，对于制定更有效的艾滋病毒预防和护理战略具有重要意义。我们评估了在乌干达Rakai寻求免费艾滋病护理失败的频率和决定因素。社区队列中接受自愿咨询检测的艾滋病毒阳性参与者被转介接受免费艾滋病毒护理（复方新诺明预防、CD 4监测、机会性感染治疗，以及在有指征时接受抗逆转录病毒治疗）。我们使用对数二项回归估计了接受VCT后6个月未登记入组护理的比例和调整的患病风险比（adj. PRR）。在Rakai社区队列研究中，约有1 145名艾滋病毒阳性参与者接受了自愿咨询和检测，并被转介接受护理。然而，31.5%（361/1145）的患者在转诊后6个月未接受艾滋病毒护理。男性（38%）的未入组率显著高于女性（29%，p = 0.005）。与未入组相关的其他因素包括：（15-24岁，调整PRR = 2.22; 95% CI：1.64，3.00），独居（adj. PRR = 2.22; 95% CI：1.57，3.15）;或在有1-2名共同居民的家庭中（adj. PRR = 1.63; 95%CI：1.31，2.03），或CD 4计数>250个细胞/ul（adj. PRR = 1.81; 95%CI：1.38，2.46）。在登记的388个细胞/ul（IQR：211，589）中，CD 4计数中位数低于未登记的509个细胞/ul（IQR：321，754）。男子、青年、CD 4计数较高的人和社会孤立程度较高的人不使用服务的情况最多，这表明需要有针对性的战略来提高服务的利用率。
Improved understanding of HIV-related health-seeking behavior at a population level is important in informing the design of more effective HIV prevention and care strategies. We assessed the frequency and determinants of failure to seek free HIV care in Rakai, Uganda. HIV-positive participants in a community cohort who accepted VCT were referred for free HIV care (cotrimoxazole prophylaxis, CD4 monitoring, treatment of opportunistic infections, and, when indicated, antiretroviral therapy). We estimated proportion and adjusted Prevalence Risk Ratios (adj. PRR) of non-enrollment into care six months after receipt of VCT using log-binomial regression. About 1145 HIV-positive participants in the Rakai Community Cohort Study accepted VCT and were referred for care. However, 31.5% (361/1145) did not enroll into HIV care six months after referral. Non-enrollment was significantly higher among men (38%) compared to women (29%, p = 0.005). Other factors associated with non-enrollment included: younger age (15-24 years, adj. PRR = 2.22; 95% CI: 1.64, 3.00), living alone (adj. PRR = 2.22; 95% CI: 1.57, 3.15); or in households with 1-2 co-residents (adj. PRR = 1.63; 95% CI: 1.31, 2.03) compared to three or more co-residents, or a CD4 count >250 cells/ul (adj. PRR = 1.81; 95% CI: 1.38, 2.46). Median (IQR) CD4 count was lower among enrolled 388 cells/ul (IQR: 211,589) compared to those not enrolled 509 cells/ul (IQR: 321,754).About one-third of HIV-positive persons failed to utilize community-based free services. Non-use of services was greatest among men, the young, persons with higher CD4 counts and the more socially isolated, suggesting a need for targeted strategies to enhance service uptake.