Shorter Meghan M, Ostermann Jan, Crump John A, Tribble Alison C, Itemba Dafrosa K, Mgonja Anna, Mtalo Antipas, Bartlett John A, Shao John F, Schimana Werner, Thielman Nathan M
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
J Acquir Immune Defic Syndr. 2009 Dec;52(5):648-54. doi: 10.1097/QAI.0b013e3181b31a6a.
We evaluated changes in characteristics of clients presenting for voluntary counseling and testing (VCT) before and during care and treatment center (CTC) scale-up activities in Moshi, Tanzania, between November 2003 and December 2007.
Consecutive clients were surveyed after pretest counseling, and rapid HIV antibody testing was performed. Trend tests were used to assess changes in seroprevalence and client characteristics over time. Multivariable logistic regression models were used to estimate the contribution of changes in sociodemographic and behavioral risk characteristics, and symptoms, to changes in seroprevalence before and during CTC scale-up.
Data from 4391 first-time VCT clients were analyzed. HIV seroprevalence decreased from 26.2% to 18.9% after the availability of free antiretroviral therapy and expansion of CTCs beyond regional and referral hospitals. Seroprevalence decreased by 27 % for females (P = 0.0002) and 34% for males (P = 0.0125). Declines in seropositivity coincided with decreases in symptoms among males and females (P < 0.0001) and a more favorable distribution of sociodemographic risks among females (P = 0.002). No changes in behavioral risk characteristics were observed.
Concurrent with the scale-up of CTCs, HIV seroprevalence and rates of symptoms declined sharply at an established freestanding VCT site in Moshi, Tanzania. If more HIV-infected persons access VCT at sites where antiretrovirals are offered, freestanding VCT sites may become a less cost-effective means for HIV case finding.
我们评估了2003年11月至2007年12月期间，在坦桑尼亚莫希的护理和治疗中心（CTC）扩大活动之前及期间，前来进行自愿咨询和检测（VCT）的服务对象特征的变化。
在进行检测前咨询后，对连续的服务对象进行调查，并进行快速HIV抗体检测。采用趋势检验来评估血清阳性率和服务对象特征随时间的变化。使用多变量逻辑回归模型来估计社会人口统计学和行为风险特征以及症状的变化对CTC扩大之前及期间血清阳性率变化的影响。
分析了4391名首次接受VCT服务对象的数据。在免费抗逆转录病毒治疗可用且CTC扩展至区域医院和转诊医院之外后，HIV血清阳性率从26.2%降至18.9%。女性血清阳性率下降了27%（P = 0.0002），男性下降了34%（P = 0.0125）。血清阳性率的下降与男性和女性症状的减少同时出现（P < 0.0001），并且女性社会人口统计学风险的分布更有利（P = 0.002）。未观察到行为风险特征的变化。
在坦桑尼亚莫希一个已有的独立VCT站点，随着CTC的扩大，HIV血清阳性率和症状发生率急剧下降。如果更多HIV感染者在提供抗逆转录病毒药物的站点接受VCT，独立的VCT站点可能会成为一种成本效益较低的HIV病例发现方式。
