Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)
Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)
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DOI：
10.1080/16549716.2019.1679472
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发表时间：
2019-01-01
影响因子：
2.6
通讯作者：
Davies, Mary-Ann
中科院分区：
文献类型：
--
作者：
Chihana, Menard L.;Huerga, Helena;Davies, Mary-Ann
背景：尽管抗逆转录病毒治疗 (ART) 规模化取得了实质性进展，但一些艾滋病毒感染者 (PLHIV) 仍然出现晚期艾滋病毒疾病，导致持续的艾滋病毒相关发病率和死亡率。目标：我们的目的是对撒哈拉以南非洲三个艾滋病毒高流行地区的晚期艾滋病毒的人口水平估计进行量化。方法：在（Ndhiwa（肯尼亚）：2012 年 9 月至 11 月）、（Chiradzulu（马拉维）：2013 年 2 月至 5 月）和（Eshowe（南非）：2013 年 7 月至 10 月）进行了 3 次横断面调查。同意的 15-59 岁符合条件的个人在家中接受采访，如果 HIV 检测呈阳性，则进行快速 HIV 检测和 CD4 计数检测。晚期 HIV 定义为 CD4 < 200 个细胞/μl。我们使用逻辑回归来确定与晚期 HIV 相关的患者特征。结果：在 18,991 人（39.2% 男性）中，4113 人（21.7%）检测出 HIV 呈阳性； 385/3957 例（9.7%（95% 置信区间 [CI]：8.8?10.7））患有晚期 HIV，范围从 7.8%（95%CI 6.4?9.5）Chiradzulu（马拉维）到 11.8%（95%CI 9.8?14.2）Ndhiwa（肯尼亚）。患有晚期疾病的 PLHIV 比例男性为 15.3% (95% CI 13.2?17.5)，高于女性 7.5% (95% CI 6.6?8.6) p < 0.001。总体而言，所有晚期艾滋病毒感染者中，62.7% 的人了解自己的艾滋病毒状况，40.3% 的人目前正在接受抗逆转录病毒治疗。总体而言，未接受 ART 的患者中有 65.6% 之前未被诊断出感染 HIV，而接受 ART 的患者中只有 29.6% 接受 ART 时间长达 6 个月左右。患有晚期 HIV 疾病的个体更有可能是男性（调整后的比值比 [aOR]；2.1 (95%CI 1.7?2.6)，并且更有可能不接受 ART (aOR；1.7 (95%CI 1.3?2.1)）。结论：在我们的研究中，大约十分之一的 PLHIV 患有晚期 HIV，其中近 40% 的人不知道自己的 HIV 状况。然而，相当大比例的患者我们的研究结果表明，需要双重关注替代检测策略，以更早地识别 PLHIV 并提高 ART 的保留率。
Background: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality. Objective: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa. Methods: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September?November 2012), (Chiradzulu (Malawi): February?May 2013) and (Eshowe (South Africa): July?October 2013). Eligible individuals 15?59 years old who consented were interviewed at home followed by rapid HIV test and CD4 count test if tested HIV-positive. Advanced HIV was defined as CD4 < 200 cells/?l. We used logistic regression to identify patient characteristics associated with advanced HIV. Results: Among 18,991 (39.2% male) individuals, 4113 (21.7%) tested HIV-positive; 385/3957 (9.7% (95% Confidence Interval [CI]: 8.8?10.7)) had advanced HIV, ranging from 7.8% (95%CI 6.4?9.5) Chiradzulu (Malawi) to 11.8% (95%CI 9.8?14.2) Ndhiwa (Kenya). The proportion of PLHIV with advanced disease was higher among men 15.3% (95% CI 13.2?17.5) than women 7.5% (95%CI 6.6?8.6) p < 0.001. Overall, 62.7% of all individuals with advanced HIV were aware of their HIV status and 40.3% were currently on ART. Overall, 65.6% of individuals not on ART had not previously been diagnosed with HIV, while only 29.6% of those on ART had been on ART for ?6 months. Individuals with advanced HIV disease were more likely to be men (adjusted Odds Ratio [aOR]; 2.1 (95%CI 1.7?2.6), and more likely not to be on ART (aOR; 1.7 (95%CI 1.3?2.1). Conclusion: In our study, about 1 in 10 PLHIV had advanced HIV with nearly 40% of them unaware of their HIV status. However, a substantial proportion of patients with advanced HIV were established on ART. Our findings suggest the need for a dual focus on alternative testing strategies to identify PLHIV earlier as well as improving ART retention.