Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) Uganda Research Unit on AIDS, PO Box 49 Entebbe, Uganda.
Trop Med Int Health. 2012 Aug;17(8):e49-57. doi: 10.1111/j.1365-3156.2012.02942.x.
To investigate antiretroviral therapy (ART) uptake after its introduction in 2004 in a longitudinal population-based cohort and its nested clinical cohort in rural Uganda.
A HIV serosurvey of all adults aged ≥ 15 years is conducted annually. Two intervals were selected for analysis. Interval 1 (November 2004-October 2006) provided 2 years of follow-up to prospectively evaluate access to HIV services. Interval 2 (November 2007-October 2008) was used to evaluate current coverage of services. Logistic regression was used to identify sociodemographic factors associated with ART screening within 2 years of diagnosis. ART coverage was assessed using Weibull survival models to estimate the numbers needing ART.
In Interval 1, 636 HIV-positive adults were resident and 295 (46.4%) knew their status. Of those, 248 (84.1%) were screened for ART within 2 years of diagnosis. After adjusting for age, those who were widowed, separated or never married were more likely to be screened than those who were married. In Interval 2, 575 HIV-positive adults were residents, 322 (56.0%) knew their status, 255 (44.3%) had been screened for ART and 189 (32.9%) had started ART. Estimated ART coverage was 66%.
In this cohort, ART access and uptake is very high once people are diagnosed. Owing to intensive screening in the study clinic, nearly all participants who were eligible initiated ART. However, this is unlikely to reflect coverage in the general population, intensified efforts are needed to promote HIV testing, and ART screening and uptake are needed among those found to be HIV-positive.
在 2004 年引入抗逆转录病毒疗法（ART）后，在乌干达农村进行一项基于人群的纵向队列研究及其嵌套临床队列研究，以调查该疗法的使用情况。
每年对所有≥15 岁的成年人进行 HIV 血清学检测。选择两个时间间隔进行分析。间隔 1（2004 年 11 月至 2006 年 10 月）提供了 2 年的随访时间，以前瞻性评估获得 HIV 服务的机会。间隔 2（2007 年 11 月至 2008 年 10 月）用于评估当前服务的覆盖范围。采用逻辑回归确定与诊断后 2 年内接受 ART 筛查相关的社会人口统计学因素。采用威布尔生存模型评估 ART 覆盖率，以估计需要接受 ART 的人数。
在间隔 1 中，有 636 名 HIV 阳性成年人居住在该地区，其中 295 名（46.4%）知晓自己的 HIV 感染状况。在这些人中，有 248 名（84.1%）在诊断后 2 年内接受了 ART 筛查。在调整年龄因素后，丧偶、离异或未婚者比已婚者更有可能接受筛查。在间隔 2 中，有 575 名 HIV 阳性成年人居住在该地区，其中 322 名（56.0%）知晓自己的 HIV 感染状况，有 255 名（44.3%）接受了 ART 筛查，有 189 名（32.9%）开始接受 ART 治疗。估计的 ART 覆盖率为 66%。
在本队列中，一旦人们被诊断出 HIV 感染，获得和接受 ART 的机会非常高。由于研究诊所的强化筛查，几乎所有符合条件的参与者都开始接受 ART 治疗。然而，这可能无法反映一般人群的覆盖率，需要加强努力促进 HIV 检测，并在发现 HIV 阳性的人群中开展 ART 筛查和接受治疗。
