What Is the Impact of Home-Based HIV Counseling and Testing on the Clinical Status of Newly Enrolled Adults in a Large HIV Care Program in Western Kenya?
What Is the Impact of Home-Based HIV Counseling and Testing on the Clinical Status of Newly Enrolled Adults in a Large HIV Care Program in Western Kenya?
复制标题
DOI：
10.1093/cid/cir789
复制
发表时间：
2012-01-15
影响因子：
11.8
通讯作者：
Braitstein, Paula
中科院分区：
文献类型：
--
作者：
Wachira, Juddy;Kimaiyo, Sylvester;Braitstein, Paula
背景。本文描述了进入人类免疫缺陷病毒 (HIV) 护理计划对首次到 USAID-AMPATH（美国国际开发署 - 提供医疗保健的学术模式）合作诊所进行 HIV 护理的成年人临床状况的影响。方法。 2008 年 8 月至 2010 年 4 月期间入组的所有年龄 >= 14 岁的患者均被纳入。 USAID-AMPATH 诊所的切入点包括家庭咨询和检测 (HBCT)、提供者发起的检测和咨询 (PITC)、结核病诊所的 HIV 检测以及自愿咨询和检测 (VCT)。计算了趋势检验，并使用多变量逻辑回归来比较 HBCT 与其他切入点对控制年龄和性别的主要结局的影响。结果。有 19 552 名符合资格的个人。其中，946 例在 HBCT 中进行检测，10 261 例在 VCT 中进行检测，8073 例在 PITC 中进行检测，272 例在结核病诊所进行检测。 HBCT、VCT、PITC 和结核病诊所的 HIV 检测呈阳性的入组 CD4 细胞计数中位数（四分位数范围）分别为 323 (194-491)、217 (87-404)、190 (70-371) 和 136 个细胞/mm(3) (59-266) (P < .001)。与在结核病诊所诊断出 HIV 感染的患者相比，在控制年龄和性别的情况下，HBCT 检测呈阳性的患者在入组时不太可能患有世界卫生组织 III 期或 IV 期 HIV 感染（调整后比值比 [AOR]，0.04；95% 置信区间 [CI]，0.03-0.06），入组时 CD4 细胞计数 < 200 个细胞/mm(3) 的可能性较小（AOR， 0.20；95% CI，0.14-.28），并且不太可能因主诉而接受护理（AOR，0.08；95% CI，0.05-.12）。结论。 HBCT 可以有效地让 HIV 感染者在患病前参加 HIV 护理。
Background. This article describes the effect point of entry into the human immunodeficiency virus (HIV) care program had on the clinical status of adults presenting for the first time to USAID-AMPATH (US Agency for International Development-Academic Model Providing Access to Healthcare) Partnership clinics for HIV care.Methods. All patients aged >= 14 years enrolled between August 2008 and April 2010 were included. Points of entry to USAID-AMPATH clinics were home-based counseling and testing (HBCT), provider-initiated testing and counseling (PITC), HIV testing in the tuberculosis clinic, and voluntary counseling and testing (VCT). Tests for trend were calculated, and multivariable logistic regression was used to compare the effect of HBCT versus other points of entry on primary outcomes controlling for age and sex.Results. There were 19 552 eligible individuals. Of these, 946 tested in HBCT, 10 261 in VCT, 8073 in PITC, and 272 in the tuberculosis clinic. The median (interquartile range) enrollment CD4 cell counts among those who tested HIV positive was 323 (194-491), 217 (87-404), 190 (70-371), and 136 cells/mm(3) (59-266) for HBCT, VCT, PITC, and the tuberculosis clinic, respectively (P < .001). Compared with those patients whose HIV infection was diagnosed in the tuberculosis clinic, those who tested positive in HBCT were, controlling for age and sex, less likely to have to have World Health Organization stage III or IV HIV infection at enrollment (adjusted odds ratio [AOR], 0.04; 95% confidence interval [CI], .03-.06), less likely to enroll with a CD4 cell count of < 200 cells/mm(3) (AOR, 0.20; 95% CI, .14-.28), and less likely to enroll into care with a chief complaint (AOR, 0.08; 95% CI, .05-.12).Conclusions. HBCT is effective at getting HIV-infected persons enrolled in HIV care before they become ill.