Antiretroviral Therapy Availability and HIV Disclosure to Spouse in Rakai, Uganda: A Longitudinal Population-Based Study.
Antiretroviral Therapy Availability and HIV Disclosure to Spouse in Rakai, Uganda: A Longitudinal Population-Based Study.
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DOI：
10.1097/qai.0000000000000600
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发表时间：
2015-06-01
期刊：
影响因子：
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通讯作者：
Wawer MJ
中科院分区：
文献类型：
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作者：
Haberlen SA;Nakigozi G;Gray RH;Brahmbhatt H;Ssekasanvu J;Serwadda D;Nalugoda F;Kagaayi J;Wawer MJ
在撒哈拉以南非洲推出抗逆转录病毒疗法（ART）十年后，这种结构性变化对艾滋病毒社会方面的影响，如艾滋病毒向合作伙伴披露的比例，在很大程度上仍然无法衡量。我们使用纵向的、基于人群的数据，评估了在乌干达的Rakai，ART的引入是否与向配偶披露HIV诊断有关。我们确定了2000年至2008年期间在Rakai社区队列研究（RCCS）调查中新诊断为HIV的婚姻/同居关系中的个体，其中抗逆转录病毒治疗（ART）于2004年中期引入。使用离散时间生存分析，我们评估了自我报告的艾滋病毒披露给配偶后诊断前和后ART推出的风险，调整个人和工会的特点。在抗逆转录病毒治疗期间的披露进一步分层的抗逆转录病毒治疗的启动。该分析包括557名已婚成年人，其中264人在抗逆转录病毒疗法可用之前（2000-2004年）被诊断为艾滋病毒，293人在抗逆转录病毒疗法引入后（2005-2008年）被诊断为艾滋病毒。自我报告披露的累积发生率在ART治疗后为75.2%，而ART治疗前为58.3%（p<0.001，调整后风险1.46 [95%CI 1.16，1.83]）。在抗逆转录病毒治疗后，未接受艾滋病毒治疗的患者中观察到的披露率为39%（72/184），接受抗逆转录病毒治疗前治疗的患者中为65%（82/126），接受抗逆转录病毒治疗的患者中为85%（64/75）（p<0.001）。治疗的可获得性和使用，特别是ART的启动，与增加自我披露艾滋病毒诊断的合作伙伴。获得抗逆转录病毒疗法可能有助于防止向未感染伴侣传播，并与受感染夫妇的治疗联系起来。
A decade after the rollout of antiretroviral therapy (ART) in sub-Saharan Africa, the effects of this structural change on social aspects of HIV such as rates of HIV disclosure to partners remain largely unmeasured. We evaluated whether the introduction of ART was associated with disclosure of HIV diagnosis to spouses in Rakai, Uganda, using longitudinal, population-based data. We identified individuals in marital/cohabitating unions who were newly diagnosed with HIV in Rakai Community Cohort Study (RCCS) surveys between 2000 and 2008, where antiretroviral therapy (ART) was introduced in mid-2004. Using discrete-time survival analysis, we assessed the hazard of self-reported HIV disclosure to spouse after diagnosis pre- and post-ART rollout, adjusting for individual and union characteristics. Disclosure in the ART period was further stratified by ART initiation. The analysis included 557 married adults, 264 of whom were diagnosed with HIV before ART was available (2000-2004) and 293 diagnosed after ART was introduced (2005-2008). The cumulative incidence of self-reported disclosure was 75.2% in the post-ART period, compared to 58.3% before ART availability (p<0.001, adjusted hazard 1.46 [95% CI 1.16, 1.83]). In the post-ART period, observed disclosure rates were 39% (72/184) among those not in HIV care, 65% (82/126) among those in pre-ART care, and 85% (64/75) among persons on ART (p<0.001). Treatment availability and use, especially ART initiation, was associated with increased self-disclosure of HIV diagnosis to partners. ART access may facilitate the prevention of transmission to uninfected partners and linkage to treatment for infected couples.