Human Immunodeficiency Virus Incidence Among Women at High-Risk of Human Immunodeficiency Virus Infection Attending a Dedicated Clinic in Kampala, Uganda: 2008-2017
Human Immunodeficiency Virus Incidence Among Women at High-Risk of Human Immunodeficiency Virus Infection Attending a Dedicated Clinic in Kampala, Uganda: 2008-2017
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DOI：
10.1097/olq.0000000000000978
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发表时间：
2019-06-01
影响因子：
3.1
通讯作者：
Weiss, Helen A.
中科院分区：
文献类型：
--
作者：
Kasamba, Ivan;Nash, Stephen;Weiss, Helen A.
背景资料：在高危人群队列研究中，高损耗和不定期的人类免疫缺陷病毒（HIV）检测可能会使发病率估计值产生偏差。我们比较发病率的趋势，高风险的妇女参加一个专门的艾滋病毒预防和治疗诊所，使用常见的方法分配时发生血清转换，是否发生血清转换之间的attribute.Methods：2008年4月至2009年5月，妇女被纳入队列1，从2013年1月到队列2，然后安排随访每3个月一次。将假设血清转换区间中点的发病率趋势与分配随机点的发病率趋势进行比较。我们还比较了基于随机点的估计值，其中有和没有多重插补（MI）的参与者与attration.Results的血清状态：截至2017年5月，3084 HIV阴性女性已入组18，364诊所访问。脱落前，27.6%（6990/25354）的患者错过了访视。截至2017年8月，队列1中65.8%（426/647）的入组患者和队列2中49.0%（1194/2437）的入组患者被定义为减员。在有1次或多次随访的女性中，队列1中605例中有93例血清转化，队列2中1601例中有77例血清转化。当比较中点值和随机点值时，血清转换间隔较长的时期的发生率似乎有明显差异。在参与者的损耗升级后，损耗MI的发生率可能被高估。基于随机点（不含MI），观察结束时队列1和队列2的发病率分别为3.8/100人-年和1.8/100人-年。结论：随机点方法减弱了使用中点观察到的发病率变化。应调查在这一脆弱人群中持续多年的预防努力后的高发病率，以进一步降低发病率。
Background: High attrition and irregular testing for human immunodeficiency virus (HIV) in cohort studies for high-risk populations can bias incidence estimates. We compare incidence trends for high-risk women attending a dedicated HIV prevention and treatment clinic, using common methods for assigning when seroconversion occurs and whether seroconversion occurs among those with attrition.Methods: Between April 2008 and May 2009, women were enrolled into cohort 1 and from January 2013 into cohort 2, then scheduled for follow-up once every 3 months. Incidence trends based on assuming a midpoint in the seroconversion interval were compared with those of assigning a random-point. We also compared estimates based on the random-point with and without multiple imputation (MI) of serostatuses for participants with attrition.Results: By May 2017, 3084 HIV-negative women had been enrolled with 18,364 clinic visits. Before attrition, 27.6% (6990 of 25,354) were missed visits. By August 2017, 65.8% (426 of 647) of those enrolled in cohort 1 and 49.0% (1194 of 2437) in cohort 2 were defined with attrition. Among women with 1 or more follow-up visit, 93 of 605 in cohort 1 and 77 of 1601 in cohort 2 seroconverted. Periods with longer seroconversion intervals appeared to have noticeable differences in incidences when comparing the midpoint and random-point values. The MI for attrition is likely to have overestimated incidence after escalated attrition of participants. Based on random-point without MI for attrition, incidence at end of observation was 3.8/100 person-years in cohort 1 and 1.8/100 in cohort 2.Conclusions: The random-point approach attenuated variation in incidence observed using midpoint. The high incidence after years of ongoing prevention efforts in this vulnerable population should be investigated to further reduce incidence.