Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya.
Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya.
复制标题
DOI：
10.1186/s12889-016-3033-x
复制
发表时间：
2016-05-04
影响因子：
4.5
通讯作者：
Ilako F
中科院分区：
文献类型：
--
作者：
Muhula S;Memiah P;Mbau L;Oruko H;Baker B;Ikiara G;Mungai M;Ndirangu M;Achwoka D;Ilako F
我们研究了艾滋病毒检测和咨询（HTC）的吸收情况，以及通过社区和卫生设施检测方式在居住在肯尼亚内罗毕基贝拉非正式城市定居点的人们中提供HTC的一年多来与护理的联系。我们分析了2013年10月至2014年9月期间基于卫生设施的艾滋病毒检测和咨询以及基于社区的检测和咨询方法的项目数据。采用单变量和双变量分析方法比较两种方法对HTC的吸收和随后与护理的联系。采用二项分布法的简单正态近似法来近似比例的精确置信区间（CI）。在18,591名客户中，大多数通过基于卫生机构的检测方法进行了检测，占72.5% (n = 13485)，而通过社区检测进行检测的占27.5% （n = 5106）。通过提供者发起的检测和咨询服务在卫生设施接受检测的客户占81.7% (n = 11015)，而通过自愿咨询和检测(VCT)/客户发起的检测和咨询（CITC）服务达到18.3%。所有在基于卫生设施的检测中呈阳性的客户都成功地与项目地点或客户选择的地点的护理联系起来，而并非所有在基于社区的检测中呈阳性的客户都与护理联系起来。在该项目中接受艾滋病毒检测的所有人中，艾滋病毒感染率为5.2% （n = 52, 95% CI: 3.9% - 6.8%）。研究的主要限制包括使用汇总数据来报告通过两种检测方法获得HTC的情况，并且无法估计集水区可能进行艾滋病毒检测的人口。基于卫生设施的HTC方法使更多的客户接受了艾滋病毒检测，与基于社区的HTC方法相比，这种方法还导致在一年的艾滋病毒检测期内确定了基贝拉贫民窟更多的艾滋病毒阳性人数。事实证明，与以社区为基础的宏达医疗相比，以卫生设施为基础的宏达医疗更容易将艾滋病毒阳性患者与护理联系起来。
We examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya. We analyzed program data on health facility-based HIV testing and counselling and community- based testing and counselling approaches for the period starting October 2013 to September 2014. Univariate and bivariate analysis methods were used to compare the two approaches with regard to uptake of HTC and subsequent linkage to care. The exact Confidence Intervals (CI) to the proportions were approximated using simple normal approximation to binomial distribution method. Majority of the 18,591 clients were tested through health facility-based testing approaches 72.5 % (n = 13485) vs those tested through community-based testing comprised 27.5 % (n = 5106). More clients tested at health facilities were reached through Provider Initiated Testing and Counselling PITC 81.7 % (n = 11015) while 18.3 % were reached through Voluntary Counselling and Testing (VCT)/Client Initiated Testing and Counselling (CITC) services. All clients who tested positive during health facility-based testing were successfully linked to care either at the project sites or sites of client choice while not all who tested positive during community based testing were linked to care. The HIV prevalence among all those who were tested for HIV in the program was 5.2 % (n = 52, 95 % CI: 3.9 %–6.8 %). Key study limitation included use of aggregate data to report uptake of HTC through the two testing approaches and not being able to estimate the population in the catchment area likely to test for HIV. Health facility-based HTC approach achieved more clients tested for HIV, and this method also resulted in identifying greater numbers of people who were HIV positive in Kibera slum within one year period of testing for HIV compared to community-based HTC approach. Linking HIV positive clients to care proved much easier during health facility- based HTC compared to community- based HTC.