Status of the HIV epidemic in Manicaland, east Zimbabwe prior to the outbreak of the COVID-19 pandemic.
Status of the HIV epidemic in Manicaland, east Zimbabwe prior to the outbreak of the COVID-19 pandemic.
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DOI：
10.1371/journal.pone.0273776
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Gregson S
中科院分区：
文献类型：
--
作者：
Rao A;Moorhouse L;Maswera R;Dadirai T;Mandizvidza P;Nyamukapa C;Nayagam S;Gregson S
津巴布韦东部的马尼卡兰省艾滋病发病率很高。2018-2019年完成的第七轮马尼卡兰调查为评估COVID-19大流行开始前的疫情状况提供了机会。研究的目的是：a）估计艾滋病毒血清阳性率，并评估自上一轮调查（2012-2013年）以来流行率是否下降，B）描述和分析艾滋病毒感染的社会人口和行为风险因素，以及c）描述艾滋病毒治疗级联。向参与者发放个人问卷，收集有关社会人口特征、性关系、艾滋病毒预防方法和治疗机会的数据，并进行艾滋病毒检测。描述性分析后，单变量和多变量分析的HIV血清阳性的危险因素，使用logistic回归模型的基础上的近端决定因素的框架。艾滋病毒感染率为11.3% [95% CI; 10.6-12.0]，45-49岁的女性感染率高于男性。自2012-2013年以来，30-44岁男性和20-44岁女性的艾滋病毒感染率显著下降。自2012-2013年以来，艾滋病毒流行病已经老化，艾滋病毒阳性者的平均年龄从38岁增加到41岁。艾滋病毒流行率的社会人口决定因素是男性的教会教派，女性的地点类型、财富状况、就业部门和饮酒，以及男女的年龄和婚姻状况。与艾滋病毒感染几率增加相关的行为决定因素是，男性和女性有更多的固定性伴侣（终生）、非固定性伴侣（终生）和使用避孕套，女性初次性行为较早和伴随性传播感染;医学包皮环切术对男性具有保护作用。在我们的研究中，检测呈阳性的参与者对艾滋病毒状况的认识较低，为66.2%。在我们的研究中，艾滋病毒检测呈阳性的所有参与者的抗逆转录病毒治疗覆盖率为65.0%，城市地区低于农村地区，尤其是男性。自2012-2013年以来，流行率下降，抗逆转录病毒治疗覆盖率增加。在我们的数据中没有观察到理论框架假设的与患病率的大多数关联，这可能是由于性风险行为的报告不足，或者尽管性风险行为水平很高，但ART的治疗即预防作用减少了传播的可能性。要进一步减少艾滋病毒感染率，就必须加强初级预防、艾滋病毒检测和与危险行为咨询服务的联系。我们的研究结果是一个有价值的基线，可用于衡量新冠肺炎大流行对津巴布韦马尼卡兰艾滋病毒流行率及其决定因素的影响，并采取适当的目标干预措施。
Manicaland province in eastern Zimbabwe has a high incidence of HIV. Completion of the seventh round of the Manicaland Survey in 2018–2019 provided the opportunity to assess the state of the epidemic prior to the start of the COVID-19 pandemic. The study aims were to: a) estimate HIV seroprevalence and assess whether prevalence has declined since the last round of the survey (2012–2013), b) describe and analyse the socio-demographic and behavioural risk factors for HIV infection and c) describe the HIV treatment cascade. Participants were administered individual questionnaires collecting data on socio-demographic characteristics, sexual relationships, HIV prevention methods and treatment access, and were tested for HIV. Descriptive analyses were followed by univariate and multivariate analyses of risk factors for HIV seropositvity using logistic regression modelling based on the proximate-determinants framework. HIV prevalence was 11.3% [95% CI; 10.6–12.0] and was higher in females than males up to 45–49 years. Since 2012–2013 HIV prevalence has significantly declined in 30–44 year-olds in males, and 20–44 year-olds in females. The HIV epidemic has aged since 2012–2013, with an increase in the mean age of HIV positive persons from 38 to 41 years. Socio-demographic determinants of HIV prevalence were church denomination in males, site-type, wealth-status, employment sector and alcohol use in females, and age and marital status in both sexes. Behavioural determinants associated with increased odds of HIV were a higher number of regular sexual partners (lifetime), non-regular sexual partners (lifetime) and condom use in both sexes, and early sexual debut and concomitant STIs in females; medical circumcision was protective in males. HIV status awareness among participants testing positive in our study was low at 66.2%. ART coverage amongst all participants testing positive for HIV in our study was 65.0% and was lower in urban areas than rural areas, particularly in males. Prevalence has declined, and ART coverage increased, since 2012–2013. Majority of the associations with prevalence hypothesised by the theoretical framework were not observed in our data, likely due to underreporting of sexual risk behaviours or the treatment-as-prevention effect of ART curtailing the probability of transmission despite high levels of sexual risk behaviour. Further reductions in HIV incidence require strengthened primary prevention, HIV testing and linkage to risk behaviour counselling services. Our results serve as a valuable baseline against which to measure the impact of the COVID-19 pandemic on HIV prevalence and its determinants in Manicaland, Zimbabwe, and target interventions appropriately.
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影响因子：
15.1
作者：
Jewell BL;Smith JA;Hallett TB
通讯作者：
Hallett TB
影响因子：
3.6
作者：
Gregson, S;Mushati, P;Nyamukapa, C
通讯作者：
Nyamukapa, C
影响因子：
3.7
作者：
Manzou R;Schumacher C;Gregson S
通讯作者：
Gregson S
影响因子：
7.7
作者：
Lopman, Ben;Nyamukapa, Constance;Gregson, Simon
通讯作者：
Gregson, Simon
DOI：
10.3390/ijerph18052477
发表时间：
2021-03-03
影响因子：
--
作者：
Damulak PP;Ismail S;Abdul Manaf R;Mohd Said S;Agbaji O
通讯作者：
Agbaji O