Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
PLoS One. 2011 Jan 31;6(1):e16488. doi: 10.1371/journal.pone.0016488.
Optimally, expanded HIV testing programs should reduce barriers to testing while attracting new and high-risk testers. We assessed barriers to testing and HIV risk among clients participating in mobile voluntary counseling and testing (MVCT) campaigns in four rural villages in the Kilimanjaro Region of Tanzania.
Between December 2007 and April 2008, 878 MVCT participants and 506 randomly selected community residents who did not access MVCT were surveyed. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing between MVCT participants and community residents who did not access MVCT. Gender-specific logistic regression models were used to describe differences in socioeconomic characteristics, HIV exposure risk, testing histories, HIV related stigma, and attitudes toward testing, between the two groups.
MVCT clients reported greater HIV exposure risk (OR 1.20 [1.04 to 1.38] for males; OR 1.11 [1.03 to 1.19] for females). Female MVCT clients were more likely to report low household expenditures (OR 1.47 [1.04 to 2.05]), male clients reported higher rates of unstable income sources (OR 1.99 [1.22 to 3.24]). First-time testers were more likely than non-testers to cite distance to testing sites as a reason for not having previously tested (OR 2.17 [1.05 to 4.48] for males; OR 5.95 [2.85 to 12.45] for females). HIV-related stigma, fears of testing or test disclosure, and not being able to leave work were strongly associated with non-participation in MVCT (ORs from 0.11 to 0.84).
MVCT attracted clients with increased exposure risk and fewer economic resources; HIV related stigma and testing-related fears remained barriers to testing. MVCT did not disproportionately attract either first-time or frequent repeat testers. Educational campaigns to reduce stigma and fears of testing could improve the effectiveness of MVCT in attracting new and high-risk populations.
理想情况下，扩大的 HIV 检测计划应减少检测障碍，同时吸引新的和高风险的检测者。我们评估了坦桑尼亚乞力马扎罗地区四个农村村庄参与流动自愿咨询和检测 (MVCT) 活动的客户的检测障碍和 HIV 风险。
2007 年 12 月至 2008 年 4 月，对 878 名 MVCT 参与者和 506 名随机选择的未接受 MVCT 的社区居民进行了调查。使用性别特异性逻辑回归模型描述了 MVCT 参与者与未接受 MVCT 的社区居民之间在社会经济特征、HIV 暴露风险、检测史、与 HIV 相关的耻辱感以及对检测的态度方面的差异。
MVCT 客户报告的 HIV 暴露风险更高（男性为 1.20 [1.04 至 1.38]；女性为 1.11 [1.03 至 1.19]）。女性 MVCT 客户更有可能报告家庭支出低（OR 1.47 [1.04 至 2.05]），男性客户报告不稳定收入来源的比例更高（OR 1.99 [1.22 至 3.24]）。首次检测者比未检测者更有可能将检测点的距离作为之前未检测的原因（男性为 2.17 [1.05 至 4.48]；女性为 5.95 [2.85 至 12.45]）。与 HIV 相关的耻辱感、对检测或检测披露的恐惧以及无法离开工作是不参与 MVCT 的主要原因（OR 从 0.11 到 0.84）。
MVCT 吸引了具有更高暴露风险和较少经济资源的客户；与 HIV 相关的耻辱感和对检测的恐惧仍然是检测的障碍。MVCT 并没有不成比例地吸引首次或频繁重复检测者。减少耻辱感和对检测的恐惧的教育活动可以提高 MVCT 吸引新的和高风险人群的效果。
