Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe.
Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe.
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DOI：
10.1371/journal.pmed.0030238
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发表时间：
2006-07
期刊：
影响因子：
15.8
通讯作者：
Hayes RJ
中科院分区：
文献类型：
--
作者：
Corbett EL;Dauya E;Matambo R;Cheung YB;Makamure B;Bassett MT;Chandiwana S;Munyati S;Mason PR;Butterworth AE;Godfrey-Faussett P;Hayes RJ
艾滋病毒咨询和检测是艾滋病毒护理和艾滋病毒预防的关键组成部分，但目前使用率很低。我们调查了工作场所快速艾滋病毒检测对自愿咨询和检测（VCT）的影响。该研究是两种VCT策略的集群随机试验，以商业职业健康诊所为随机化单位。直接向所有员工提供VCT，随后是2年的开放式VCT和基本艾滋病毒护理。企业被随机分配到在其职业诊所进行现场快速艾滋病毒检测（11家企业）或在同样使用快速检测的连锁独立中心进行场外VCT代金券（11家企业）。要求所有员工进行基线匿名HIV血清学检测。在随机分配到现场和非现场VCT的企业中，艾滋病毒感染率分别为19.8%和18.4%。在随机接受现场测试的3950名诊所员工中，1957人接受了VCT（平均接受51.1%），而在随机接受非现场测试的诊所，3532名员工中有586人接受了代金券（平均接受19.2%）。在对潜在混杂因素进行调整后，现场VCT与接受代金券的风险比为2.8（95%置信区间为1.8 - 3.8）。只有125名员工（平均现场使用率为4.3%）报告使用了他们的代金券，因此，与非现场VCT相比，现场VCT的真实调整风险比可能高达12.5（95%置信区间为8.2至16.8）。迫切需要高影响力的VCT战略，以便在非洲最大限度地预防艾滋病毒和获得护理。如果在现场提供并与艾滋病毒基本护理相结合，工作场所的VCT有可能获得较高的接受率。便利性和可及性似乎在社区VCT的可接受性中起着关键作用。自从25年前报告了第一例艾滋病（获得性免疫缺陷综合症）以来，艾滋病已成为一种主要的世界性流行病，2005年有300万人死于艾滋病。艾滋病是由人类免疫缺陷病毒（HIV）引起的，通常通过与受感染的伴侣发生无保护的性行为传播。艾滋病毒破坏免疫系统，使受感染的人无法抵抗其他病毒和细菌。艾滋病毒感染可以用称为“抗逆转录病毒药物”的药物进行治疗。为了应对这一全球性流行病，世界各国领导人已承诺到2010年使所有需要的人都能普遍获得这些药物。不幸的是，尽管获得抗逆转录病毒药物的机会正在迅速增加，但感染艾滋病毒的人数也在迅速增加。去年，大约有500万新的艾滋病毒感染者，这表明需要更加重视预防，以阻止或扭转艾滋病毒和艾滋病的传播。艾滋病毒感染检测是预防工作的一个重要组成部分，但在全球范围内，只有10%需要检测的人能够获得检测。即使在有这种服务的地方，也很少有人使用它们，因为感染艾滋病毒会带来耻辱，而且害怕受到歧视。人们对决定一个人是否决定进行艾滋病毒检测的因素了解有限。然而，为了减少艾滋病毒的传播，必须尽可能多地对有感染风险的人进行检测。vct是一种结合了自愿检测和HIV感染的含义以及如何避免传播病毒的咨询的方法，以往的研究表明，获得检测的便利性、是否直接提供检测以及提供检测的工作人员的态度都非常重要。在这项研究中，研究人员询问，在工作场所提供VCT是否可以提高艾滋病毒/艾滋病流行最广泛的非洲对艾滋病毒检测的“吸收”。在津巴布韦，25%的成年人携带艾滋病毒，研究人员确定了拥有职业健康诊所的企业，并将其分为两个“干预”组。一半企业的员工被提供“现场VCT”——测试前咨询，然后是当天的现场快速测试、结果和测试后咨询。其他公司的员工也得到了同样的检测前咨询，但他们得到了一张在非现场检测中心进行艾滋病毒检测的代金券，之后还可以预约讨论结果——即所谓的非现场VCT。如果需要，每个人都有同样的机会获得有限的艾滋病毒护理。虽然有一半的现场VCT员工接受了HIV检测，但只有五分之一的非现场VCT员工接受了检测券，其中只有五分之一的人真正使用了他们的代金券。这意味着现场VCT导致的艾滋病毒检测大约是场外VCT的12倍。在这两项干预中，大多数接受测试的人在进入研究后很快就接受了测试，很少有人接受了一次以上的测试。最后，25岁或以下的人、体力劳动者和单身人士最有可能接受两种干预措施的测试。这些结果表明，工作场所的现场VCT可能是改善非洲目前低水平艾滋病毒检测的一种方法，并且间歇性地提供VCT可能与连续提供一样有效。重要的是，研究人员说，他们的研究结果表明，测试可及性的相对较小的变化可以转化为测试吸收的重大差异。这在非职业环境中也适用。然而，这些观察结果需要在更多的企业和其他环境中重复，包括那些没有相关艾滋病毒护理的环境，然后才能推广。此外，本研究报告了这种提供VCT的方法的可接受性，但没有报告其对艾滋病毒预防的影响。因此，结果并不能表明工作场所VCT是否能像其他提供VCT的方式一样有效地预防艾滋病毒的传播。这将需要研究艾滋病毒阴性员工和艾滋病毒阳性员工的伴侣之间的艾滋病毒发病率如何受到不同的VCT策略的影响。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.0030238访问这些网站。•美国国家过敏和传染病研究所关于艾滋病毒感染和艾滋病的情况介绍•美国卫生和公众服务部关于艾滋病毒/艾滋病治疗、预防、•美国疾病控制和预防中心关于艾滋病毒/艾滋病的信息•艾滋病规划署（联合国艾滋病毒/艾滋病联合规划署）关于艾滋病毒/艾滋病流行病相关政治问题的信息以及2004年艾滋病规划署/世界卫生组织关于艾滋病毒检测的政策声明•艾滋病地图：•MedlinePlus关于艾滋病毒/艾滋病的百科全书条目，如果在工作场所现场提供艾滋病毒自愿咨询和检测，并将其与基本艾滋病毒护理联系起来，就有可能获得很高的接受率。
HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT). The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8). High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT. Since the first case of AIDS (acquired immunodeficiency syndrome) was reported 25 years ago, AIDS has become a major worldwide epidemic, with 3 million people dying from it in 2005. AIDS is caused by the human immunodeficiency virus (HIV), which is usually spread through unprotected sex with an infected partner. HIV damages the immune system, leaving infected individuals unable to fight off other viruses and bacteria. HIV infections can be treated with drugs know as “antiretrovirals,” and in an effort to deal with the global epidemic, world leaders have committed themselves to providing universal access to these drugs for everyone who needs them by 2010. Unfortunately, although access to antiretrovirals is rapidly increasing, so is the number of people infected with HIV. Last year, there were about 5 million new HIV infections, suggesting that more emphasis on prevention will be needed to halt or reverse the spread of HIV and AIDS. An important part of prevention is testing for HIV infection, but globally only 10% of people who need testing can access it. And even where such services are available, few people use them because of the stigma attached to HIV infection and fear of discrimination. There is limited understanding about the factors that determine whether an individual will decide to have an HIV test. Yet, to reduce HIV spread, as many people at risk of infection must be tested as possible. Previous studies on VCT—a combination of voluntary testing and counseling about the implications of HIV infection and how to avoid transmitting the virus—have indicated that the convenience of getting the test, whether the test is directly offered, and the attitude of staff supplying it are all very important. In this study, the researchers asked whether providing VCT in the workplace could improve the “uptake” of HIV testing in Africa, where the HIV/AIDS epidemic is most widespread. The researchers identified businesses with occupational health clinics in Zimbabwe, a country where 25% of adults carry HIV, and divided them into two “intervention” groups. Employees at half the businesses were offered “on-site VCT”—pre-test counseling followed by same-day on-site rapid testing, results, and post-test counseling. Employees at the other businesses had the same pre-test counseling but were offered a voucher for an HIV test at an off-site testing center and a later appointment to discuss the results—so-called off-site VCT. Everyone had the same access to limited HIV care should they need it. Although half of the employees at the on-site VCT businesses took up the option of HIV testing, only a fifth of employees at the off-site VCT businesses accepted vouchers for testing, and only one in five of these people actually used their voucher. This means that on-site VCT resulted in about 12 times as many HIV tests as off-site VCT. In both interventions, most of the people who accepted testing did so soon after entering the study and very few people were tested more than once. Finally, people 25 years old or younger, manual workers, and single people were most likely to accept testing in both interventions. These results suggest that on-site VCT in the workplace might be one way to improve uptake of HIV testing in Africa from its current low level and that providing VCT intermittently might be as effective as continuous provision. Importantly, say the researchers, the results of their study show that a relatively minor change in accessibility to testing can translate into a major difference in test uptake. This may hold true in non-occupational settings. However, these observations need to be repeated in more businesses and other settings, including those where there is no linked HIV care, before they can be generalized. Also, this study reports on the acceptability of this approach to providing VCT, but not on its impact on HIV prevention. As such the results do not indicate whether workplace VCT prevents HIV spread as effectively as other ways of delivering VCT. This will require research investigating how HIV incidence among HIV-negative employees and the partners of HIV-positive employees are affected by different VCT strategies. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030238. • United States National Institute of Allergy and Infectious Diseases factsheet on HIV infection and AIDS • United States Department of Health and Human Services information on HIV/AIDS treatment, prevention, and research • US Centers for Disease Control and Prevention information on HIV/AIDS • UNAIDS (Joint United Nations Programme on HIV/AIDS) information on political issues related to the HIV/AIDS epidemic and the 2004 UNAIDS/World Health Organization policy statement on HIV testing • Aidsmap: information on HIV and AIDS provided by the charity NAM, which includes the latest scientific and political news • MedlinePlus encyclopedia entry on HIV/AIDS Voluntary counseling and testing for HIV has the potential for high uptake when it is offered on-site at the workplace and linked to basic HIV care.
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影响因子：
120.7
作者：
ALLEN, S;SERUFILIRA, A;HULLEY, S
通讯作者：
HULLEY, S
影响因子：
11.8
作者：
Matambo, R;Dauya, E;Corbett, EL
通讯作者：
Corbett, EL
影响因子：
3.8
作者：
Malonza, IA;Richardson, BA;Stewart, GCJ
通讯作者：
Stewart, GCJ
影响因子：
3.3
作者：
Matovu, JKB;Kigozi, G;Gray, RH
通讯作者：
Gray, RH
影响因子：
3.8
作者：
Cartoux, M;Msellati, P;Dabis, F
通讯作者：
Dabis, F