Implementation of a Community-Based Hybrid HIV Testing Services Program as a Strategy to Saturate Testing Coverage in Western Kenya
Implementation of a Community-Based Hybrid HIV Testing Services Program as a Strategy to Saturate Testing Coverage in Western Kenya
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DOI：
10.1097/qai.0000000000002160
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发表时间：
2019-12-01
影响因子：
3.6
通讯作者：
Cohen, Craig R.
中科院分区：
文献类型：
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作者：
Truong, Hong-Ha M.;Akama, Eliud;Cohen, Craig R.
背景资料：了解艾滋病毒状况是与预防、护理和治疗联系起来的切入点，也是实现艾滋病规划署90-90-90目标的第一步。大多数国家依靠替代指标来估计检测饱和度，包括定期基于人口的抽样和产量（检测者中的阳性人数）。我们进行了一个以社区为基础的“混合”HIV检测服务（HTS）计划，以识别不知道自己HIV阳性状态的人。设置：肯尼亚荷马湾县; 2016年7月至9月。艾滋病毒检测资格是基于2015年国家指南。以前未确定的分数（PUF）被定义为新确定的艾滋病毒感染者（PLWH）的比例出所有以前确定的和新确定的PLWH.Results：混合HTS计划达到28,885人总数：25,340居民和3545非居民。通过社区保健中心和跟踪服务，接触了19 288人。在11 316名有资格接受艾滋病毒检测的人中，有9 463人（83%）接受了检测，其中包括1 230人（13%）是首次检测。在1589名艾滋病毒阳性者中，有115名新发现的艾滋病毒感染者，占PUF的7.2%。93个新确定的PLWH在CHCs，68%的启动同一天的抗逆转录病毒therapy.Conclusion：混合HTS程序确定以前不知道自己的艾滋病毒阳性状态的人，从而使连接到护理和同一天的治疗，并减少传播风险。一种侧重于识别不知道自己艾滋病毒阳性状态的人并结合确定PUF的方法有可能更好地确定检测策略，以识别社区中90%以上的艾滋病毒携带者。
Background: Knowledge of HIV status is the entry point for linkage to prevention, care, and treatment, and the first step toward achieving the UNAIDS 90-90-90 targets. Most countries rely on proxies for estimating testing saturation, including periodic population-based sampling and yield (number positive among those tested). We conducted a community-based "Hybrid" HIV testing services (HTS) program to identify persons unaware of their HIV-positive status.Setting: Homa Bay County, Kenya; July-September, 2016.Methods: We conducted community mapping, household census, multi-disease community health campaigns (CHCs), and home-based tracking. HIV testing eligibility was based on 2015 national guidelines. The previously unidentified fraction (PUF) was defined as the proportion of newly identified persons living with HIV (PLWH) out of all previously identified and newly identified PLWH.Results: The Hybrid HTS program reached 28,885 persons in total: 25,340 residents and 3545 nonresidents. There were 19,288 persons reached through CHCs and tracking. Of 11,316 individuals eligible for HIV testing, 9463 (83%) accepted testing, including 1230 (13%) first-time testers. There were 115 newly identified PLWH of 1589 total HIV-positive persons, representing a 7.2% PUF. Of 93 newly identified PLWH at the CHCs, 68% initiated same-day antiretroviral therapy.Conclusion: The Hybrid HTS program identified persons previously unaware of their HIV-positive status, thereby enabling linkage to care and same-day treatment and reducing onward transmission risk. An approach focused on identifying persons unaware of their HIV-positive status in combination with ascertaining the PUF has the potential to better target testing strategies to identify >90% of PLWH in a community.