Initiation of antiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study.
Initiation of antiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study.
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DOI：
10.1016/s2352-3018(14)70024-4
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发表时间：
2014-11
期刊：
影响因子：
16.1
通讯作者：
Celum, Connie
中科院分区：
文献类型：
--
作者：
Barnabas, Ruanne V.;van Rooyen, Heidi;Tumwesigye, Elioda;Murnane, Pamela M.;Baeten, Jared M.;Humphries, Hilton;Turyamureeba, Bosco;Joseph, Philip;Krows, Meighan;Hughes, James P.;Celum, Connie
抗逆转录病毒治疗（ART）通过抑制HIV病毒载量，显著降低HIV相关的发病率、死亡率和HIV传播。在艾滋病毒流行率高的情况下，需要制定外联战略，以发现无症状的艾滋病毒阳性者，将他们与艾滋病毒护理和抗逆转录病毒疗法联系起来，并实现病毒抑制。我们在南非夸祖鲁-纳塔尔和乌干达姆巴巴拉地区的两个农村社区进行了一项前瞻性干预研究。干预措施包括家庭艾滋病毒检测和咨询（HTC），艾滋病毒阳性者的护理点CD 4计数检测，转介护理，以及一个月然后每季度的非专业顾问随访。12个月时的结果是与护理的联系，以及在符合ART条件的HIV阳性患者中开始ART和病毒抑制（CD 4 ≤350个细胞/μL）。3，393名成年人接受了艾滋病毒检测（覆盖率为96%），其中635人（19%）为艾滋病毒阳性。在基线时，36%的艾滋病毒阳性者是新发现的（64%以前已知是艾滋病毒阳性），40%正在接受抗逆转录病毒治疗。到第12个月，619（97%）的艾滋病毒阳性者访问了艾滋病毒诊所，123名符合抗逆转录病毒治疗条件的参与者中，94（76%）在12个月前开始抗逆转录病毒治疗。在第9个月接受ART的77名参与者中，59名（77%）在第12个月达到病毒抑制。在所有艾滋病毒阳性者中，病毒抑制（<1，000拷贝/mL）的比例在12个月时从50%增加到65%（p=<0.001）。在南非和乌干达农村地区，基于社区的艾滋病毒/艾滋病委员会实现了较高的检测覆盖率和与护理的联系。在那些有资格接受抗逆转录病毒治疗的人中，很高比例的人开始接受抗逆转录病毒治疗并实现了病毒抑制，这表明依从性很高。应评估非洲现有社区卫生工作者实施这一人道主义援助方法的情况，以确定其有效性和成本。
Antiretroviral therapy (ART) significantly decreases HIV-associated morbidity, mortality, and HIV transmission through HIV viral load suppression. In high HIV prevalence settings, outreach strategies are needed to find asymptomatic HIV positive persons, link them to HIV care and ART, and achieve viral suppression. We conducted a prospective intervention study in two rural communities in KwaZulu-Natal, South Africa, and Mbabara district, Uganda. The intervention included home HIV testing and counseling (HTC), point-of-care CD4 count testing for HIV positive persons, referral to care, and one month then quarterly lay counselor follow-up visits. The outcomes at 12 months were linkage to care, and ART initiation and viral suppression among HIV positive persons eligible for ART (CD4≤350 cells/μL). 3,393 adults were tested for HIV (96% coverage), of whom 635 (19%) were HIV positive. At baseline, 36% of HIV positive persons were newly identified (64% were previously known to be HIV positive) and 40% were taking ART. By month 12, 619 (97%) of HIV positive persons visited an HIV clinic, and of 123 ART eligible participants, 94 (76%) initiated ART by 12 months. Of the 77 participants on ART by month 9, 59 (77%) achieved viral suppression by month 12. Among all HIV positive persons, the proportion with viral suppression (<1,000 copies/mL) increased from 50% to 65% (p=<0.001) at 12 months. Community-based HTC in rural South Africa and Uganda achieved high testing coverage and linkage to care. Among those eligible for ART, a high proportion initiated ART and achieved viral suppression, indicating high adherence. Implementation of this HTC approach by existing community health workers in Africa should be evaluated to determine effectiveness and costs.