Grésenguet Gérard, Séhonou Jean, Bassirou Bouba, Longo Jean De Dieu, Malkin Jean-Elie, Brogan Tom, Bélec Laurent
Centre National de Référence des Maladies Sexuellement Transmission et du SIDA, Bangui, République Centrafricaine.
J Acquir Immune Defic Syndr. 2002 Sep 1;31(1):106-14. doi: 10.1097/00126334-200209010-00014.
In July 1997, the National Reference Center for Sexually Transmitted Diseases of Bangui, Central African Republic (CAR), was expanded by the creation of an anonymous and voluntary counseling and testing (VCT) unit for HIV infection, the Anonymous Surveillance Unit (Unité de Dépistage Anonyme [UDA]). The goal of the UDA was to initiate and promote voluntary HIV testing in the general adult population of Bangui. We carried out an observational and comprehensive survey over a 4-year period to document and analyze the experience of VCT in the UDA, with special attention to risk factors associated with HIV infection.
All clients for VCT were given adequate pretest counseling by trained counselors focused on knowledge about HIV infection and sexually transmitted infections, individual risks of acquiring HIV, and anticipation of the client's attitude about test results. After consent was obtained, a blood sample was drawn and tested for HIV by two ELISAs in parallel. The client paid a standard cost of $1.20 at the initial visit. After a week, test results were given to the client during the posttest visit, at which time HIV-seropositive individuals received emotional support and were referred to specific social or medical structures. Seronegative clients received reinforcement of prevention messages and were asked to come back for serologic follow-up free of charge after 3 (M3) and 12 (M12) months.
From July 1997 to March 2001, 5686 individuals aged 14 to 65 years (mean age, 27 years) had an initial visit for VCT (V1). Peaks of UDA visitation (250-450 clients) were observed on the annual AIDS Day in the CAR, at which time HIV serologic testing was offered free of charge. A total of 5060 (89%) clients came back for a second visit (V2) to receive test results. Among those, 18.3% were infected with HIV type 1. Multivariate analysis of risk factors demonstrated marked association of HIV seropositivity with age, female gender, widowed/divorced women, poor or low education level, occupations such as civil servants or merchants, presence of symptoms of sexually transmitted infections, and lack of systematic condom use. Single young women were at higher risk for HIV infection compared with men of the same age (OR = 7.7 for women aged 15-24 years, 95% CI: 4.0-14.0; OR = 2.8 for women aged 25-34 years, 95% CI: 1.7-4.5). Widowed women older than 44 years of age were more likely to be HIV-seropositive than men (OR = 10.0; 95% CI: 1.7-83.6). A total of 885 (21%) HIV-seronegative individuals returned for follow-up at 3 months (M3; 0.45% rate of seroconversion). Seventy-nine (9%) individuals returned at 12 months (M12), without any new cases of HIV infection. HIV-negative clients consulting at M3 and M12 showed a significant reduction in unprotected intercourse with occasional sexual partners.
This experience demonstrates that VCT for HIV infection is feasible in Central Africa.
1997年7月，中非共和国班吉的国家性传播疾病参考中心进行了扩建，增设了一个针对艾滋病毒感染的匿名自愿咨询检测（VCT）部门，即匿名监测部门（Unité de Dépistage Anonyme [UDA]）。UDA的目标是在班吉的普通成年人群中开展并推广自愿艾滋病毒检测。我们在4年时间里进行了一项观察性综合调查，以记录和分析UDA中VCT的经验，特别关注与艾滋病毒感染相关的风险因素。
所有VCT的客户都由经过培训的咨询师给予充分的检测前咨询，内容包括关于艾滋病毒感染和性传播感染的知识、感染艾滋病毒的个人风险以及对客户对检测结果态度的预期。在获得同意后，采集血样并通过两种酶联免疫吸附测定法（ELISA）并行检测艾滋病毒。客户在初次就诊时支付1.20美元的标准费用。一周后，在检测后就诊时将检测结果告知客户，此时艾滋病毒血清阳性个体获得情感支持并被转介到特定的社会或医疗机构。血清阴性的客户会收到预防信息强化，并被要求在3个月（M3）和12个月（M12）后免费回来进行血清学随访。
从1997年7月到2001年3月，5686名年龄在14至65岁（平均年龄27岁）的人进行了VCT的初次就诊（V1）。在中非共和国的年度艾滋病日观察到UDA就诊高峰（250 - 450名客户），此时提供免费的艾滋病毒血清学检测。共有5060名（89%）客户回来进行第二次就诊（V2）以获取检测结果。其中，18.3%感染了1型艾滋病毒。风险因素的多变量分析表明，艾滋病毒血清阳性与年龄、女性性别、丧偶/离婚女性、教育水平低或差、公务员或商人等职业、性传播感染症状的存在以及缺乏系统性使用避孕套显著相关。与同龄男性相比，单身年轻女性感染艾滋病毒的风险更高（15 - 24岁女性的比值比[OR] = 7.7，95%置信区间[CI]：4.0 - 14.0；25 - 34岁女性的OR = 2.8，95% CI：1.7 - 4.5）。44岁以上的丧偶女性比男性更有可能艾滋病毒血清阳性（OR = 10.0；95% CI：1.7 - 83.6）。共有885名（21%）艾滋病毒血清阴性个体在3个月时回来进行随访（M3；血清转化率为0.45%）。79名（9%）个体在12个月时（M12）回来，没有新的艾滋病毒感染病例。在M3和M12进行咨询的艾滋病毒阴性客户与偶尔性伴侣的无保护性行为显著减少。
这一经验表明，在中非进行艾滋病毒感染的VCT是可行的。
