Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study.
Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study.
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DOI：
10.1136/bmjopen-2016-013733
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发表时间：
2017-04-12
期刊：
影响因子：
2.9
通讯作者：
Zarowsky C
中科院分区：
文献类型：
--
作者：
Sanga ES;Lerebo W;Mushi AK;Clowes P;Olomi W;Maboko L;Zarowsky C
与护理挂钩是艾滋病毒检测与艾滋病毒治疗、护理和支助之间的桥梁。在坦桑尼亚，移动的检测旨在解决检测率历来较低的问题。据报告，2009年与护理有关的比例为14%，2014年为28%。该研究比较了在艾滋病毒诊断的前6个月内，在移动的/外展和基于公共卫生设施的服务中检测的艾滋病毒阳性者与护理的联系。 坦桑尼亚姆贝亚地区四个区的农村社区。来自16个检测机构的1012名新诊断的HIV阳性成年人被纳入一个双臂队列，并在2014年8月至2015年7月期间随访6个月。 840名（83%）参与者完成了研究。我们使用Kaplan-Meier估计量和对数秩检验比较了与护理相关的比率和时间方差。考克斯比例风险回归模型，以评估与时间变异相关的因素。在6个月结束时，78%的受访者已经连接到护理，不同的测试模型之间存在差异。 84%（CI 81%至87%，n=512）的个人在设施为基础的网站测试与护理相比，69%（CI 65%至74%，n=281）的个人在移动的/外展测试。基于设施的站点的链接中位时间为1天（IQR：1-7.5），移动的/外展站点的链接中位时间为6天（IQR：3-11）。 当控制其他变量时，在基于设施的站点测试的参与者比在移动的/外展测试的参与者链接的可能性高78%（AHR=1.78; 95% CI 1.52至2.07）。向家人/亲属披露艾滋病毒状况与护理联系显著相关（AHR=2.64; 95%CI 2.05至3.39）。自2014年以来，坦桑尼亚农村地区艾滋病毒检测呈阳性后与护理的联系在各种检测模式中显着增加。个人测试在设施为基础的网站链接的比例显着更高，适度快于移动的/推广测试的个人。移动的/外展检测模式使艾滋病毒检测服务更接近人们。需要制定战略，改善与移动的/外联模式的联系。
Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV-positive individuals tested at mobile/outreach versus public health facility-based services within the first 6 months of HIV diagnosis. Rural communities in four districts of Mbeya Region, Tanzania. A total of 1012 newly diagnosed HIV-positive adults from 16 testing facilities were enrolled into a two-armed cohort and followed for 6 months between August 2014 and July 2015. 840 (83%) participants completed the study. We compared the ratios and time variance in linkage to care using the Kaplan-Meier estimator and Log rank tests. Cox proportional hazards regression models to evaluate factors associated with time variance in linkage. At the end of 6 months, 78% of all respondents had linked into care, with differences across testing models. 84% (CI 81% to 87%, n=512) of individuals tested at facility-based site were linked to care compared to 69% (CI 65% to 74%, n=281) of individuals tested at mobile/outreach. The median time to linkage was 1 day (IQR: 1–7.5) for facility-based site and 6 days (IQR: 3–11) for mobile/outreach sites. Participants tested at facility-based site were 78% more likely to link than those tested at mobile/outreach when other variables were controlled (AHR=1.78; 95% CI 1.52 to 2.07). HIV status disclosure to family/relatives was significantly associated with linkage to care (AHR=2.64; 95% CI 2.05 to 3.39). Linkage to care after testing HIV positive in rural Tanzania has increased markedly since 2014, across testing models. Individuals tested at facility-based sites linked in significantly higher proportion and modestly sooner than mobile/outreach tested individuals. Mobile/outreach testing models bring HIV testing services closer to people. Strategies to improve linkage from mobile/outreach models are needed.
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影响因子：
3.7
作者：
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