Community-based HIV testing services in an urban setting in western Kenya: a programme implementation study
Community-based HIV testing services in an urban setting in western Kenya: a programme implementation study
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DOI：
10.1016/s2352-3018(20)30253-8
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发表时间：
2021-01-01
期刊：
影响因子：
16.1
通讯作者：
Cohen, Craig R.
中科院分区：
文献类型：
--
作者：
Truong, Hong-Ha M.;Mocello, A. Rain;Cohen, Craig R.
一些国家正在努力实现联合国艾滋病规划署的目标，即90%的艾滋病毒感染者知道自己的艾滋病毒状况，特别是在男性和青年中。为了识别那些不知道自己的艾滋病毒阳性状态和实现检测饱和的人，我们在肯尼亚西部的一个城市非正式定居点实施了混合艾滋病毒检测方法。在这项研究中，我们的目的是描述摄取艾滋病毒检测和连接到护理和treatment在此programme.Methods社区卫生倡议涉及社区绘图，家庭人口普查，多疾病社区卫生运动，并以家庭为基础的跟踪在非正式解决的Obunga在基苏穆，肯尼亚。在整个方案覆盖地区开展了52次多疾病社区保健运动，由认证的检测服务顾问进行艾滋病毒检测是提供的保健服务之一。年龄在15岁或以上的人以前没有被确定为艾滋病毒阳性，年龄小于15岁的儿童报告性活跃或父母或监护人要求进行测试，以及在过去3个月内测试艾滋病毒阴性但报告最近风险的人都有资格进行测试。保健和咨询服务是为男子和青年量身定做的，以鼓励他们参与。利用全球定位系统数据追踪普查期间查明的没有参加社区保健运动的个人，并提供在家艾滋病毒检测服务。我们计算了先前未确定的分数，定义为新确定为艾滋病毒阳性的人数占所有先前确定和新确定为艾滋病毒阳性的人数的比例。结果在2018年1月11日至8月29日期间，社区健康倡议计划达到23 584人，其中11 526人（48.9%）为男子和男孩，5 635人（23.9%）年龄在15-24岁之间。在12769名符合HIV检测条件的人中，12407人（97.2%）接受了检测，其中3917人（31.6%）为首次检测。在1248名艾滋病毒阳性者中，有101人新被确定为艾滋病毒阳性，占先前未确定分数的8.1%。以前未确定的分数是最高的男性（9.8%）和15-24岁的人（15.3%）。解释以社区为基础的混合艾滋病毒检测成功地在城市环境中实施。使艾滋病毒检测更容易获得和接受的创新办法，特别是对男子和年轻人来说，对于实现检测和治疗饱和至关重要。重点确定不知道自己艾滋病毒阳性状况的个人，并结合监测以前未确定的部分，有可能实现艾滋病规划署到2030年结束艾滋病的快速通道承诺。版权所有（C）2020爱思唯尔有限公司保留所有权利。
Background Some countries are struggling to reach the UNAIDS target of 90% of all individuals with HIV knowing their HIV status, especially among men and youth. To identify individuals who are unaware of their HIV-positive status and achieve testing saturation, we implemented a hybrid HIV testing approach in an urban informal settlement in western Kenya. In this study, we aimed to describe the uptake of HIV testing and linkage to care and treatment during this programme.Methods The Community Health Initiative involved community mapping, household census, multidisease community health campaigns, and home-based tracking in the informal settlement of Obunga in Kisumu, Kenya. 52 multidisease community health campaigns were held throughout the programme coverage area, at which HIV testing by certified testing service counsellors was one of the health services available. Individuals aged 15 years or older who were not previously identified as HIV-positive, children younger than 15 years who reported being sexually active or for whom testing was requested by a parent or guardian, and individuals who tested HIV-negative within the past 3 months but who reported a recent risk were all eligible for testing. Health and counselling services were tailored for men and youth to encourage their participation. Individuals identified during the census who did not attend a community health campaign were tracked using global positioning system data and offered home-based HIV testing services. We calculated the previously unidentified fraction, defined as the number of individuals who were newly identified as HIV-positive as a proportion of all individuals previously identified and newly identified as HIV-positive.Findings Between Jan 11 and Aug 29, 2018, the Community Health Initiative programme reached 23 584 individuals, of whom 11 526 (48.9%) were men and boys and 5635 (23.9%) were aged 15-24 years. Of 12 769 individuals who were eligible for HIV testing, 12407 (97.2%) accepted testing, including 3917 (31.6%) first-time testers. 101 individuals were newly identified as HIV-positive out of 1248 total individuals who were HIV-positive, representing an 8.1% previously unidentified fraction. The previously unidentified fraction was highest among men (9.8%) and among people aged 15-24 years (15.3%).Interpretation Community-based hybrid HIV testing was successfully implemented in an urban setting. Innovative approaches that make HIV testing more accessible and acceptable, particularly to men and young people, are crucial for achieving testing and treatment saturation. Focusing on identifying individuals who are unaware of their HIV-positive status in combination with monitoring the previously unidentified fraction has the potential to achieve the UNAIDS Fast Track commitment to end AIDS by 2030. Copyright (C) 2020 Elsevier Ltd. All rights reserved.