Findings from home-based HIV testing and facilitated linkage after scale-up of test and treat in rural South Africa: young people still missing
Findings from home-based HIV testing and facilitated linkage after scale-up of test and treat in rural South Africa: young people still missing
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DOI：
10.1111/hiv.12787
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发表时间：
2019-08-27
期刊：
影响因子：
3
通讯作者：
Shahmanesh, M.
中科院分区：
文献类型：
--
作者：
Baisley, K. J.;Seeley, J.;Shahmanesh, M.
目的本研究的目的是评估在南非农村引入基于家庭的艾滋病毒咨询和检测(HBHCT)和电话辅助的支持后，与艾滋病毒护理和抗逆转录病毒治疗(ART)启动的联系的比率。方法在南非夸祖鲁纳塔尔进行以人群为基础的前瞻性队列研究。所有年满15岁的居民都有资格接受HBHCT。那些检测呈阳性且不在护理中的人被转介到11家公共部门诊所中的一家接受抗逆转录病毒治疗。2周内未到诊所就诊的患者将收到短信提醒；2周后未就诊的患者将由护士顾问打电话，讨论相关问题并鼓励建立联系。使用Kaplan-Meier方法估计与护理和启动抗逆转录病毒治疗有关的新诊断个体的比例。结果受访的38827人中，26%的人接受了HBHCT。女性的摄取率高于男性(分别为30%和20%)，但年龄在30岁和=30岁的人中相似(分别为28%和26%)。共有784人(8%)艾滋病毒检测呈阳性，其中427人(54%)是新诊断的。在6个月内，31%的女性和18%的30岁男性与护理有关，分别有29%和16%的人开始接受抗逆转录病毒治疗。在那些=30岁的人中，41%的女性和38%的男性在6个月内与护理有关，分别有41%和35%的人开始接受抗逆转录病毒治疗。结论：尽管促进了关联，但HBHCT后护理和ART启动的及时关联的比率非常低，尤其是在年轻男性中。需要创新，为年轻人提供有效的艾滋病毒护理和预防干预，从而最大限度地实现普遍检测和治疗的好处。
Objectives The aim of the study was to estimate rates of linkage to HIV care and antiretroviral treatment (ART) initiation after the introduction of home-based HIV counselling and testing (HBHCT) and telephone-facilitated support for linkage in rural South Africa. Methods A population-based prospective cohort study was carried out in KwaZulu Natal, South Africa. All residents aged >= 15 years were eligible for HBHCT. Those who tested positive and were not in care were referred for ART at one of 11 public-sector clinics. Individuals who did not attend the clinic within 2 weeks were sent a short message service (SMS) reminder; those who had not attended after a further 2 weeks were telephoned by a nurse counsellor, to discuss concerns and encourage linkage. Kaplan-Meier methods were used to estimate the proportion of newly diagnosed individuals linking to care and initiating ART. Results Among 38 827 individuals visited, 26% accepted HBHCT. Uptake was higher in women than in men (30% versus 20%, respectively), but similar in people aged < 30 years and >= 30 years (28% versus 26%, respectively). A total of 784 (8%) tested HIV positive, of whom 427 (54%) were newly diagnosed. Within 6 months, 31% of women and 18% of men < 30 years old had linked to care, and 29% and 16%, respectively, had started ART. Among those >= 30 years, 41% of women and 38% of men had linked to care within 6 months, and 41% and 35%, respectively, had started ART. Conclusions Despite facilitated linkage, rates of timely linkage to care and ART initiation after HBHCT were very low, particularly among young men. Innovations are needed to provide effective HIV care and prevention interventions to young people, and thus maximize the benefits of universal test and treat.