Swaziland HIV Incidence Measurement Survey (SHIMS): a prospective national cohort study.
Swaziland HIV Incidence Measurement Survey (SHIMS): a prospective national cohort study.
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DOI：
10.1016/s2352-3018(16)30190-4
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发表时间：
2017-02
期刊：
影响因子：
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通讯作者：
Nkambule R
中科院分区：
文献类型：
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作者：
Justman J;Reed JB;Bicego G;Donnell D;Li K;Bock N;Koler A;Philip NM;Mlambo CK;Parekh BS;Duong YT;Ellenberger DL;El-Sadr WM;Nkambule R
斯威士兰是全世界艾滋病毒感染率最高的国家。斯威士兰艾滋病毒发病率测量调查根据前瞻性观察到的艾滋病毒血清转换提供了第一个全国艾滋病毒发病率估计数。采用两阶段调查抽样设计，从斯威士兰575个查点地区的14 891个家庭中选择具有全国代表性的18-49岁男女样本，他们在2011年接受了以家庭为基础的咨询和艾滋病毒快速检测。所有年龄在18-49岁之间的人，如果前一天晚上住在家里或在家里睡觉，并且愿意接受家庭艾滋病毒检测，用英语或斯瓦蒂语回答人口统计学和行为问题，并提供书面知情同意书，都有资格参加这项研究。我们进行了快速HIV检测，并在基线时使用问卷调查评估了社会人口学和行为特征，对于HIV血清阴性个体，6个月后。我们用Poisson回归模型计算HIV发病率，即每人-年的事件数× 100，我们用考克斯比例风险模型评估协变量作为预测因子。采用了调查加权，所有模型都采用了调查抽样方法。在2010年12月10日至2011年6月25日期间，11897名HIV血清阴性成人入组SHIMS，11232名（94%）接受了复检。其中，观察到145例HIV血清转化，导致加权HIV发病率为2.4%（95%CI 2.1 - 2.8）。女性的发病率（3.1%; 95% CI 2.6 - 3.7）几乎是男性（1.7%; 1.3 - 2.1，p<0.0001）的两倍。在男性中，过去6个月内伴侣的HIV阳性状态（校正风险比[aHR] 2.67，1.06 - 6.82，p= 0.040）或血清状态未知（aHR 4.64，2.32 - 9.27，p<0.0001）可预测HIV血清转换。在女性中，重要的预测因素包括未婚（aHR 2.90，1.44 - 5.84，p= 0.0030），有一个住在其他地方的配偶（aHR 2.66，1.29 - 5.45，p= 0.0078），以及在过去6个月内有一个未知HIV状态的伴侣（aHR 2.87，1.44 - 5.84，p= 0.0030）。斯威士兰是世界上艾滋病毒发病率最高的国家。在高流行率国家，需要采取基于人口的发病率措施和方案，进一步扩大艾滋病毒检测和支持披露艾滋病毒状况。总统艾滋病紧急救援计划（PEPFAR）由疾病控制和预防中心。
Swaziland has the highest national HIV prevalence worldwide. The Swaziland HIV Incidence Measurement Survey (SHIMS) provides the first national HIV incidence estimate based on prospectively observed HIV seroconversions. A two-stage survey sampling design was used to select a nationally representative sample of men and women aged 18–49 years from 14 891 households in 575 enumeration areas in Swaziland, who underwent household-based counselling and rapid HIV testing during 2011. All individuals aged 18–49 years who resided or had slept in the household the night before and were willing to undergo home-based HIV testing, answer demographic and behavioural questions in English or siSwati, and provide written informed consent were eligible for the study. We performed rapid HIV testing and assessed sociodemographic and behavioural characteristics with use of a questionnaire at baseline and, for HIV-seronegative individuals, 6 months later. We calculated HIV incidence with Poisson regression modelling as events per person-years × 100, and we assessed covariables as predictors with Cox proportional hazards modelling. Survey weighting was applied and all models used survey sampling methods. Between Dec 10, 2010, and June 25, 2011, 11 897 HIV-seronegative adults were enrolled in SHIMS and 11 232 (94%) were re-tested. Of these, 145 HIV seroconversions were observed, resulting in a weighted HIV incidence of 2·4% (95% CI 2·1–2·8). Incidence was nearly twice as high in women (3·1%; 95% CI 2·6–3·7) as in men (1·7%; 1·3–2·1, p<0·0001). Among men, partner’s HIV-positive status (adjusted hazard ratio [aHR] 2·67, 1·06–6·82, p=0·040) or unknown serostatus (aHR 4·64, 2·32–9·27, p<0·0001) in the past 6 months predicted HIV seroconversion. Among women, significant predictors included not being married (aHR 2·90, 1·44–5·84, p=0·0030), having a spouse who lives elsewhere (aHR 2·66, 1·29–5·45, p=0·0078), and having a partner in the past 6 months with unknown HIV status (aHR 2·87, 1·44–5·84, p=0·0030). Swaziland has the highest national HIV incidence in the world. In high-prevalence countries, population-based incidence measures and programmes that further expand HIV testing and support disclosure of HIV status are needed. President’s Emergency Plan for AIDS Relief (PEPFAR) by the Centers for Disease Control and Prevention.