Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH-IRe): a cluster-randomised trial
Targeted combination prevention to support female sex workers in Zimbabwe accessing and adhering to antiretrovirals for treatment and prevention of HIV (SAPPH-IRe): a cluster-randomised trial
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DOI：
10.1016/s2352-3018(18)30111-5
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发表时间：
2018-08-01
期刊：
影响因子：
16.1
通讯作者：
Hargreaves, James R.
中科院分区：
文献类型：
--
作者：
Cowan, Frances M.;Davey, Calum;Hargreaves, James R.
为了消除艾滋病毒，需要加强女性性工作者对卫生服务的参与。我们评估了在Zimbabwe.Methods女性性工作者有针对性的组合干预的有效性，我们做了一个集群随机试验，从2014年到2016年。集群是女性性工作者诊所周围的地区，并配对登记。研究中心被随机分配（1：1）接受常规护理（由同伴教育者支持的免费性健康服务，包括按需进行艾滋病毒检测、抗逆转录病毒治疗（ART）转诊和健康教育）或支持额外定期艾滋病毒检测、现场启动ART、暴露前预防、依从性和强化社区动员的干预措施。主要结果是所有女性性工作者中HIV病毒载量1000拷贝/mL或更高的比例，通过应答者驱动的抽样调查进行评估。我们使用了一个适应集群总结的方法来估计风险difference.Findings我们随机分配14个集群，以常规护理或干预（每组7个）。在研究期间，3612名女性性工作者在常规护理组和4619名干预组的诊所就诊。在常规护理组中，一半的人接受了检测（1151对2606）并被诊断为艾滋病毒阳性（546对1052）。所有女性性工作者中病毒载量为1000拷贝/毫升或更高的比例在两个研究组中都有所下降（从1363人中的421人[30%]到1443人中的279人[19%]，在常规护理组中从1303人中的399人[30%]到1439人中的240人[16%]），但在评估期结束时的风险差异仅为-2.8%（95%CI-8.1至2.5，p=0 . 23）。在HIV阳性妇女中，在评估期结束时，常规护理组869人中病毒载量低于1000拷贝/mL的比例为590人（68%），干预组828人中为588人（72%），调整后的风险差异为5.3%（95%CI-4.0至14.6，p=0.20）。我们对女性性工作者专门项目的干预导致了高水平的艾滋病毒诊断和治疗。需要进一步研究，以优化方案内容和强度，使其适用于更广泛的人群。版权所有（C）2018作者。由爱思唯尔有限公司出版。这是一篇开放获取文章，使用CC BY-NC-ND 4.0许可证。
Background Strengthening engagement of female sex workers with health services is needed to eliminate HIV. We assessed the efficacy of a targeted combination intervention for female sex workers in Zimbabwe.Methods We did a cluster-randomised trial from 2014 to 2016. Clusters were areas surrounding female sex worker clinics and were enrolled in matched pairs. Sites were randomly assigned (1:1) to receive usual care (free sexual-health services supported by peer educators, including HIV testing on demand, referral for antiretroviral therapy [ART], and health education) or an intervention that supported additional regular HIV testing, on-site initiation of ART, pre-exposure prophylaxis, adherence, and intensified community mobilisation. The primary outcome was the proportion of all female sex workers with HIV viral load 1000 copies per mL or greater, assessed through respondentdriven sampling surveys. We used an adapted cluster-summary approach to estimate risk differences.Findings We randomly assigned 14 clusters to usual care or the intervention (seven in each group). 3612 female sex workers attended clinics in the usual-care clusters and 4619 in the intervention clusters during the study. Half as many were tested (1151 vs 2606) and diagnosed as being HIV positive (546 vs 1052) in the usual-care clusters. The proportion of all female sex workers with viral loads of 1000 copies per mL or greater fell in both study groups (from 421 [30%] of 1363 to 279 [19%] of 1443 in the usual-care group and from 399 [30%] of 1303 to 240 [16%] of 1439 in the intervention group), but with a risk difference at the end of the assessment period of only -2.8% (95% CI -8.1 to 2.5, p=0 . 23). Among HIV-positive women, the proportions with viral loads less than 1000 copies per mL were 590 (68%) of 869 in the usual-care group and 588 (72%) of 828 in the intervention group at the end of the assessment period, adjusted risk difference of 5.3% (95% CI -4.0 to 14.6, p=0.20). There were no adverse events.Interpretation Our intervention of a dedicated programme for female sex workers led to high levels of HIV diagnosis and treatment. Further research is needed to optimise programme content and intensity for the broader population. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.