Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re-test during HIV-testing campaigns in rural Mozambique.
Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re-test during HIV-testing campaigns in rural Mozambique.
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DOI：
10.1002/jia2.25095
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发表时间：
2018-04
影响因子：
6
通讯作者：
Naniche D
中科院分区：
文献类型：
--
作者：
Fuente-Soro L;Lopez-Varela E;Augusto O;Sacoor C;Nhacolo A;Honwana N;Karajeanes E;Vaz P;Naniche D
对艾滋病毒感染的认识不仅限于诊断，还包括了解、接受、披露和启动艾滋病毒护理。我们的目标是描述经过重复艾滋病毒检测的艾滋病毒阳性人群的特征，但没有透露他们的血清状态以及对第一个联合国艾滋病规划署90目标的估计的影响。这项分析嵌套在莫桑比克南部建立的一个预期队列中，该队列进行了三种艾滋病毒检测模式：自愿咨询和检测(VCT)、提供者发起的咨询和检测(PICT)和基于家庭的检测(HBT)。参与者有机会向非专业辅导员自我报告自己的状况，艾滋病毒阳性诊断得到核实，表明他们以前参加过护理。这项研究包括1955名通过VCT/PICT确诊为艾滋病毒的人和11746名HBT运动的参与者。那些在检测前没有报告自己的血清状态，并被发现之前有艾滋病毒诊断的人，被定义为不披露。进行场地分层描述性分析，并通过对数二项回归估计与保密相关的因素。在第一轮2500名随机接受HBT的成年人中，1725人有资格进行检测，18.7%的人自我报告他们的艾滋病毒呈阳性。在那些检测结果为阳性的人中，38.9%被发现没有披露。在临床测试方式中也发现了类似的未披露发生率，PICT策略的29.4%(95%可信区间26.7至32.3)和VCT的13.0%(95%可信区间10.9至15.3)。与自我报告的患者相比，既往未就诊病史(调整后的患病率(APR)4.2，95%可信区间(95%CI)2.6~6.8)、较年轻的年龄(APR 2.5，95%可信区间1.4~4.4)和既往无治疗史((APR)1.4，95%可信区间1.0~2.1)与不披露显著相关。当考虑不披露为艾滋病毒携带者(PLWHIV)知道其艾滋病毒状况时，PLWHIV知晓的比例从78.3%(95%可信区间74.2至81.6)上升至86.8%(95%可信区间83.4至89.6)。超过三分之一的艾滋病毒阳性检测人员没有向咨询师透露他们之前的艾滋病毒阳性诊断。这一比例因检测方式和年龄的不同而不同。由于没有对艾滋病毒检测人员进行有效和非匿名的跟踪系统，重复检测未披露的情况会导致资源浪费，并可能扭曲方案指标。需要制定干预措施，确保适当的心理社会支持，以鼓励这些人口披露他们的状况，并优化稀缺资源。
Awareness of HIV‐infection goes beyond diagnosis, and encompasses understanding, acceptance, disclosure and initiation of the HIV‐care. We aimed to characterize the HIV‐positive population that underwent repeat HIV‐testing without disclosing their serostatus and the impact on estimates of the first UNAIDS 90 target. This analysis was nested in a prospective cohort established in southern Mozambique which conducted three HIV‐testing modalities: voluntary counselling and testing (VCT), provider‐initiated counselling and testing (PICT) and home‐based testing (HBT). Participants were given the opportunity to self‐report their status to lay counsellors and HIV‐positive diagnoses were verified for previous enrolment in care. This study included 1955 individuals diagnosed with HIV through VCT/PICT and 11,746 participants of a HBT campaign. Those who did not report their serostatus prior to testing, and were found to have a previous HIV‐diagnosis, were defined as non‐disclosures. Venue‐stratified descriptive analyses were performed and factors associated with non‐disclosure were estimated through log‐binomial regression. In the first round of 2500 adults randomized for HBT, 1725 were eligible for testing and 18.7% self‐reported their HIV‐positivity. Of those tested with a positive result, 38.9% were found to be non‐disclosures. Similar prevalence of non‐disclosures was found in clinical‐testing modalities, 29.4% (95% CI 26.7 to 32.3) for PICT strategy and 13.0% (95% CI 10.9 to 15.3) for VCT. Prior history of missed visits (adjusted prevalence ratio (APR) 4.2, 95% CI 2.6 to 6.8), younger age (APR 2.5, 95% CI 1.4 to 4.4) and no prior history of treatment ((APR) 1.4, 95% CI 1.0 to 2.1) were significantly associated with non‐disclosure as compared to patients who self‐reported. When considering non‐disclosures as people living with HIV (PLWHIV) aware of their HIV‐status, the proportion of PLWHIV aware increased from 78.3% (95% CI 74.2 to 81.6) to 86.8% (95% CI 83.4 to 89.6). More than one‐third of individuals testing HIV‐positive did not disclose their previous positive HIV‐diagnosis to counsellors. This proportion varied according to testing modality and age. In the absence of an efficient and non‐anonymous tracking system for HIV‐testers, repeat testing of non‐disclosures leads to wasted resources and may distort programmatic indicators. Developing interventions that ensure appropriate psychosocial support are needed to encourage this population to disclose their status and optimize scarce resources.
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影响因子：
4.4
作者：
Gadisa T;Tymejczyk O;Kulkarni SG;Hoffman S;Lahuerta M;Remien RH;Yigzaw M;Daba S;Elul B;Nash D;Melaku Z
通讯作者：
Melaku Z
DOI：
10.1097/qai.0000000000001081
发表时间：
2016-12-01
影响因子：
3.6
作者：
Huerga, Helena;Van Cutsem, Gilles;Ellman, Tom
通讯作者：
Ellman, Tom
影响因子：
3
作者：
Gonzalez, R.;Munguambe, K.;Naniche, D.
通讯作者：
Naniche, D.
影响因子：
4.4
作者：
Daskalopoulou, Marina;Lampe, Fiona C.;Rodger, Alison J.
通讯作者：
Rodger, Alison J.
影响因子：
3.3
作者：
Kabudula, Chodziwadziwa W.;Joubert, Jane D.;Bradshaw, Debbie
通讯作者：
Bradshaw, Debbie