HIV-Related Deaths in Nairobi, Kenya: Results From a HIV Mortuary Surveillance Study, 2015.
HIV-Related Deaths in Nairobi, Kenya: Results From a HIV Mortuary Surveillance Study, 2015.
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DOI：
10.1097/qai.0000000000001975
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发表时间：
2019-05-01
期刊：
影响因子：
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通讯作者：
Sirengo M
中科院分区：
文献类型：
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作者：
Nyagah LM;Young PW;Kim AA;Wamicwe J;Kimani M;Waruiru W;Rogena E;Oduor J;Walong E;Waruru A;Oyugi J;Downer M;De Cock KM;Sirengo M
在公共卫生艾滋病毒监测中，死亡是一个重要但往往无法测量的终点。我们试图使用一种新的基于停尸房的方法在肯尼亚内罗毕描述死亡中的艾滋病毒。从2015年1月29日至3月3日，肯雅塔国立医院和城市停尸房连续筛查了15岁的≥死亡身体。死因是从医疗档案和死亡通知单中提取的。抽取心脏血，使用国家艾滋病毒检测算法进行艾滋病毒感染检测，然后对艾滋病毒阳性样本进行病毒载量检测。在807具合格身体中，有610具(75.6%)有HIV检测结果。KNH的身体艾滋病毒阳性率为23.2%(95%可信区间为19.3-27.7)，而城市停尸房为12.6%(95%可信区间为8.8-17.8)，P<；0.001。在城市(33.3%对9.2%，p=0.008)和KNH停尸房(28.8%对19.0%，p=0.025)，女性的艾滋病毒感染率明显高于男性。一半(53.3%)感染艾滋病毒的身体在死亡前没有被诊断，另外22.2%的人是在导致死亡的住院期间才被诊断出来的。虽然没有统计学意义，但61.9%的男性之前没有确诊，而女性的这一比例为45.8%(p=0.144)。在KNH医院死前被诊断为艾滋病毒的44名身体中，有一半(52.3%)在接受治疗，之前被诊断为艾滋病毒的人中有五分之一(22.7%)实现了病毒抑制。在内罗毕，艾滋病毒感染率在死亡中很高，特别是在妇女中，而身体的先前诊断很低。建立例行的太平间监测有助于监测送往太平间的身体中与艾滋病毒有关的死亡情况。
Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya. Cadavers aged ≥15 years at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29th to March 3rd 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples. Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI 19.3–27.7) compared to City Mortuary at 12.6% (95% CI 8.8–17.8), p<0.001. HIV prevalence was significantly higher among women than men at both City (33.3% versus 9.2%, p=0.008) and KNH Mortuary (28.8% versus 19.0%, p=0.025). Half (53.3%) of HIV infected cadavers had no diagnosis prior to death and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no prior diagnosis compared to 45.8% of females (p=0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis prior to death were on treatment, and one in five (22.7%) with a prior diagnosis had achieved viral suppression. HIV prevalence was high among deaths in Nairobi, especially among women, and prior diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.