Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
J Int AIDS Soc. 2012 Sep 24;15(2):17352. doi: 10.7448/IAS.15.2.17352.
Building on earlier works demonstrating the effectiveness and acceptability of provider-initiated counselling and testing (PITC) services in integrated outpatient departments of urban primary healthcare clinics (PHCs), this study seeks to understand the relative utility of PITC services for identifying clients with early-stage HIV-related disease compared to traditional voluntary testing and counselling (VCT) services. We additionally seek to determine whether there are any significant differences in the clinical and demographic profile of PITC and VCT clients.
Routinely collected, de-identified data were collated from two cohorts of HIV-positive patients referred for HIV treatment, either from PITC or VCT in seven urban-integrated PHCs. Univariate and multivariate analyses were conducted to compare the two cohorts across demographic and clinical characteristics at enrolment.
Forty-five per cent of clients diagnosed via PITC had CD4 < 200, and more than 70% (i.e. two thirds) had CD4 < 350 at enrollment, with significantly lower CD4 counts than that of VCT clients (p < 0.001). PITC clients were more likely to be male (p = 0.0005) and less likely to have secondary or tertiary education (p < 0.0001). Among those who were initiated on antiretroviral therapy (ART), PITC clients had lower odds of initiating treatment within four weeks of enrollment into HIV care (adjusted odds ratio, or AOR: 0.86; 95% confidence interval, or CI: 0.75-0.99; p = 0.035) and significantly lower odds of retention in care at six months (AOR: 0.84; CI: 0.77-0.99; p = 0.004).
In Lusaka, Zambia, large numbers of individuals with late-stage HIV are being incidentally diagnosed in outpatient settings. Our findings suggest that PITC in this setting does not facilitate more timely diagnosis and referral to care but rather act as a "safety net" for individuals who are unwilling or unable to seek testing independently. Further work is needed to document the way provision of clinic-based services can be strengthened and linked to community-based interventions and to address socio-cultural norms and socio-economic status that underpin healthcare-seeking behaviour.
在先前的研究中，已经证明在城市基层医疗诊所（PHC）的综合门诊部门提供医务人员主导的咨询和检测（PITC）服务的有效性和可接受性，本研究旨在了解与传统的自愿咨询和检测（VCT）服务相比，PITC 服务在识别早期 HIV 相关疾病患者方面的相对效用。我们还试图确定 PITC 和 VCT 患者的临床和人口统计学特征是否存在任何显著差异。
从两个 HIV 阳性患者队列中收集了常规收集的、去识别的资料，这些队列分别是从七个城市综合 PHC 的 PITC 或 VCT 中转介到 HIV 治疗的患者。采用单变量和多变量分析比较两组患者在入组时的人口统计学和临床特征。
通过 PITC 诊断的患者中，有 45%的患者 CD4 计数<200，超过 70%（即三分之二）的患者在入组时 CD4 计数<350，与 VCT 患者相比，CD4 计数显著较低（p<0.001）。PITC 患者更可能是男性（p=0.0005），接受过中学或高等教育的可能性较小（p<0.0001）。在开始接受抗逆转录病毒治疗（ART）的患者中，PITC 患者在入组 HIV 护理后四周内开始治疗的可能性较低（调整后的优势比，或 AOR：0.86；95%置信区间，或 CI：0.75-0.99；p=0.035），在六个月时保持在护理中的可能性显著较低（AOR：0.84；CI：0.77-0.99；p=0.004）。
在赞比亚卢萨卡，大量晚期 HIV 患者在门诊环境中被偶然诊断出来。我们的研究结果表明，在这种环境下，PITC 并不能促进更及时的诊断和转介到护理，但它更像是一个“安全网”，为那些不愿意或无法独立寻求检测的人提供服务。需要进一步努力记录诊所提供的服务如何得到加强，并与社区干预措施联系起来，以解决支持寻求医疗保健行为的社会文化规范和社会经济地位问题。
