The impact of voluntary counselling and testing services on sexual behaviour change and HIV incidence: observations from a cohort study in rural Tanzania
The impact of voluntary counselling and testing services on sexual behaviour change and HIV incidence: observations from a cohort study in rural Tanzania
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DOI：
10.1186/1471-2334-14-159
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发表时间：
2014-03-22
影响因子：
3.7
通讯作者：
Zaba, Basia
中科院分区：
文献类型：
--
作者：
Cawley, Caoimhe;Wringe, Alison;Zaba, Basia
背景资料：人们普遍认为，自愿咨询和检测服务通过激励服务对象减少性风险，有助于预防艾滋病毒。然而，撒哈拉以南非洲的调查结果喜忧参半，特别是在艾滋病毒抗体阴性者中。我们探讨了VCT使用和性风险行为和艾滋病毒发病率的变化之间的关联，从一个社区艾滋病毒队列研究在西北Tanzan.Methods的数据：VCT使用，性行为和艾滋病毒感染状况的数据，可从三个艾滋病毒血清学监测轮在2003-4（Sero 4），2006-7（Sero 5）和2010年（Sero 6）。我们使用多项逻辑回归，以评估轮之间的性风险行为的变化，泊松回归估计HIV incidence.Results：分析包括3,613参加Sero 4和Sero 5（3,474 HIV阴性和139 HIV阳性在较早的一轮）和2,998参加Sero 5和Sero 6（2,858 HIV阴性和140 HIV阳性在较早的一轮）。在艾滋病毒阴性的人中，VCT的使用与去年性伴侣数量的减少有关（aRR塞罗斯4-5：1.42，95% CI 1.07-1.88; aRR塞罗斯5-6：1.68，95% CI 1.25-2.26）和在过去一年中有非同居伴侣的可能性（aRR塞罗斯4-5：1.57，95% CI 1.10-2.25; aRR塞罗斯5-6：1.48，95% CI 1.07-2.04）或过去一年中的高风险伴侣（aRR塞罗斯5-6 1.57，95% CI 1.06-2.31）。然而，VCT也与非同居伴侣在塞罗斯4-5之间停止使用安全套有关（aRR 4.88，95%CI 1.39-17.16）。有没有统计学显着的艾滋病毒发病率的变化之间的VCT使用和变化，也没有在艾滋病毒阳性的个人，可能是由于小的样本sizes.Conclusions性行为的变化：我们发现适度的VCT使用和减少一些艾滋病毒阴性的参与者之间的性风险行为的关联，但没有影响艾滋病毒阳性的个人在低的整体VCT摄取的背景下。此外，有没有显着的变化，艾滋病毒的发病率与VCT的使用，虽然下降的背景发病率和小样本量可能会阻止我们检测到这一点。自愿咨询和检测服务的影响最终将取决于接受率，需要进一步研究，以更好地了解使用自愿咨询和检测服务后的行为变化过程。
Background: It is widely assumed that voluntary counselling and testing (VCT) services contribute to HIV prevention by motivating clients to reduce sexual risk-taking. However, findings from sub-Saharan Africa have been mixed, particularly among HIV-negative persons. We explored associations between VCT use and changes in sexual risk behaviours and HIV incidence using data from a community HIV cohort study in northwest Tanzania.Methods: Data on VCT use, sexual behaviour and HIV status were available from three HIV serological surveillance rounds undertaken in 2003-4 (Sero4), 2006-7 (Sero5) and 2010 (Sero6). We used multinomial logistic regression to assess changes in sexual risk behaviours between rounds, and Poisson regression to estimate HIV incidence.Results: The analyses included 3,613 participants attending Sero4 and Sero5 (3,474 HIV-negative and 139 HIV-positive at earlier round) and 2,998 attending Sero5 and Sero6 (2,858 HIV-negative and 140 HIV-positive at earlier round). Among HIV-negative individuals VCT use was associated with reductions in the number of sexual partners in the last year (aRR Seros 4-5: 1.42, 95% CI 1.07-1.88; aRR Seros 5-6: 1.68, 95% CI 1.25-2.26) and in the likelihood of having a non-cohabiting partner in the last year (aRR Seros 4-5: 1.57, 95% CI 1.10-2.25; aRR Seros 5-6: 1.48, 95% CI 1.07-2.04) or a high-risk partner in the last year (aRR Seros 5-6 1.57, 95% CI 1.06-2.31). However, VCT was also associated with stopping using condoms with non-cohabiting partners between Seros 4-5 (aRR 4.88, 95% CI 1.39-17.16). There were no statistically significant associations between VCT use and changes in HIV incidence, nor changes in sexual behaviour among HIV-positive individuals, possibly due to small sample sizes.Conclusions: We found moderate associations between VCT use and reductions in some sexual risk behaviours among HIV-negative participants, but no impacts among HIV-positive individuals in the context of low overall VCT uptake. Furthermore, there were no significant changes in HIV incidence associated with VCT use, although declining background incidence and small sample sizes may have prevented us from detecting this. The impact of VCT services will ultimately depend upon rates of uptake, with further research required to better understand processes of behaviour change following VCT use.