Community-wide HIV testing, linkage case management, and defaulter tracing in Bukoba, Tanzania: pre-intervention and post-intervention, population-based survey evaluation.
Community-wide HIV testing, linkage case management, and defaulter tracing in Bukoba, Tanzania: pre-intervention and post-intervention, population-based survey evaluation.
复制标题
坦桑尼亚布科巴市的社区范围内的艾滋病毒测试，联系案例管理和违约者追踪：干预前和干预后，基于人群的调查评估。
DOI：
10.1016/s2352-3018(20)30199-5
复制
发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Rwebembera A
中科院分区：
文献类型：
--
作者：
Steiner C;MacKellar D;Cham HJ;Rwabiyago OE;Maruyama H;Msumi O;Pals S;Weber R;Kundi G;Byrd J;Kazaura K;Madevu-Matson C;Morales F;Justman J;Rutachunzibwa T;Rwebembera A
社区随机试验在实施联合预防策略方面取得了不同程度的成功，这些策略诊断出90%的艾滋病毒感染者，在90%的确诊患者中开始并保持抗逆转录病毒治疗（ART），并在90%的抗逆转录病毒治疗患者中实现病毒载量抑制（90-90-90）。布科巴联合预防评估（BCPE）旨在通过扩大新的艾滋病毒检测、联系和保留干预措施，在坦桑尼亚布科巴市议会实现90-90-90的目标。我们在bukoba（位于坦桑尼亚维多利亚湖西岸的一个城乡混合委员会，约有15万名居民）社区干预前后进行了以人口为基础的横断面调查。2014年10月1日至2017年3月31日，在布科巴的11家政府支持的卫生保健机构实施了BCPE干预措施，当时国家art资格指南从CD4细胞计数每μL少于350个细胞（2014年10月1日至2015年12月31日）和每μL少于500个细胞（2016年1月1日至2016年9月30日）扩展到任何CD4细胞计数（2016年10月1日至2017年3月31日）。我们采用干预前（2013年11月4日- 2014年1月25日）和干预后（2017年6月21日- 2017年9月20日）人口为基础的家庭调查，评估18-49岁居民中未确诊HIV感染的人口患病率和抗逆转录病毒治疗覆盖率，以及向90-90-90迈进的进展。在为期2年的干预期间，BCPE进行了133 695次艾滋病毒检测，在11个Bukoba设施诊断并将3918名艾滋病毒感染者与艾滋病毒治疗联系起来，并使604名停止治疗的患者重新接受艾滋病毒治疗。4795和5067名18-49岁的居民参加了干预前和干预后的调查。干预前后的HIV患病率相似：干预前为8.9% (95% CI为7.5 ~ 0.10)；干预后8.4%（6.9 - 9.9）。未确诊的艾滋病毒感染率从4.7%下降到2.0%（患病率为0.42,95% CI为0.31 - 0.57），目前所有艾滋病毒感染者的抗逆转录病毒治疗使用率从32.2%增加到70.9%(2.20,1.82 - 2·66)，男性从23.0%增加到62.1%(2.70,1.84 - 3·96)，18-29岁人群从16.7%增加到64%（3.87,2.54 - 5·89）。在参与干预前和干预后调查的436名和435名18-49岁艾滋病毒感染者中，先前的艾滋病毒诊断从47.4%（41.3 - 53.4）增加到76.2%(71.8 - 806)，诊断的艾滋病毒感染者中使用抗逆转录病毒治疗的人数从68.0%（60.9 - 72.5）增加到93.1%(92.0 - 96.0)，抗逆转录病毒治疗的病毒载量抑制从88.7%（83.6 - 93.8）增加到91.3%（88.6 - 94.1）。BCPE的研究结果表明，扩大推荐的艾滋病毒检测、联系和保留干预措施有助于减少未确诊艾滋病毒感染的流行，增加所有艾滋病毒感染者的抗逆转录病毒治疗使用，并在相对较短的时间内实现90-90-90目标取得实质性进展。目前正在全国范围内扩大基于BCPE设施的检测和联动干预措施，以帮助坦桑尼亚实现90-90-90的目标。美国总统艾滋病紧急救援计划。
Community randomised trials have had mixed success in implementing combination prevention strategies that diagnose 90% of people living with HIV, initiate and retain on antiretroviral therapy (ART) 90% of those diagnosed, and achieve viral load suppression in 90% of those on ART (90-90-90). The Bukoba Combination Prevention Evaluation (BCPE) aimed to achieve 90-90-90 in Bukoba Municipal Council, Tanzania, by scaling up new HIV testing, linkage, and retention interventions. We did population-based, cross-sectional surveys before and after our community-wide intervention in Bukoba—a mixed urban and rural council of approximately 150 000 residents located on the western shore of Lake Victoria in Tanzania. BCPE interventions were implemented in 11 government-supported health-care facilities throughout Bukoba from Oct 1, 2014, to March 31, 2017, when national ART-eligibility guidelines expanded from CD4 counts of less than 350 cells per μL (Oct 1, 2014–Dec 31, 2015) and 500 or less cells per μL (Jan 1, 2016–Sept 30, 2016) to any CD4 cell count (test and treat, Oct 1, 2016–March 31, 2017). We used pre-intervention (Nov 4, 2013–Jan 25, 2014) and post-intervention (June 21, 2017–Sept 20, 2017) population-based household surveys to assess population prevalence of undiagnosed HIV infection and ART coverage, and progress towards 90-90-90, among residents aged 18–49 years. During the 2·5-year intervention, BCPE did 133 695 HIV tests, diagnosed and linked 3918 people living with HIV to HIV care at 11 Bukoba facilities, and returned to HIV care 604 patients who had stopped care. 4795 and 5067 residents aged 18–49 years participated in pre-intervention and post-intervention surveys. HIV prevalence before and after the intervention was similar: pre-intervention 8·9% (95% CI 7·5–10·4); post-intervention 8·4% (6·9–9·9). Prevalence of undiagnosed HIV infection decreased from 4·7% to 2·0% (prevalence ratio 0·42, 95% CI 0·31–0·57), and current ART use among all people living with HIV increased from 32·2% to 70·9% (2·20, 1·82–2·66) overall, 23·0% to 62·1% among men (2·70, 1·84–3·96), and 16·7% to 64·4% among people aged 18–29 years (3·87, 2·54–5·89). Of 436 and 435 people living with HIV aged 18–49 years who participated in pre-intervention and post-intervention surveys, previous HIV diagnosis increased from 47·4% (41·3–53·4) to 76·2% (71·8–80·6), ART use among diagnosed people living with HIV increased from 68·0% (60·9–75·2) to 93·1% (90·2–96·0), and viral load suppression of those on ART increased from 88·7% (83·6–93·8) to 91·3% (88·6–94·1). BCPE findings suggest scaling up recommended HIV testing, linkage, and retention interventions can help reduce prevalence of undiagnosed HIV infection, increase ART use among all people living with HIV, and make substantial progress towards achieving 90-90-90 in a relatively short period. BCPE facility-based testing and linkage interventions are undergoing national scale up to help achieve 90-90-90 in Tanzania. US Presidents’ Emergency Plan for AIDS Relief.