aDepartment of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA bAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa cDepartment of Obstetrics and Gynecology dGlobal Health Institute, Duke University, Durham, North Carolina eDepartment of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts fDepartment of Medicine, School of Medicine gDepartment of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA hAcademic Unit of Human Development and Health, University of Southampton, Southampton, UK.
AIDS. 2013 Nov 13;27(17):2765-73. doi: 10.1097/01.aids.0000432454.68357.6a.
OBJECTIVE: Youth aged 15-24 years in sub-Saharan Africa are at a high risk for HIV acquisition and urgently need HIV prevention interventions. HIV counselling and testing (HCT) is designed to promote HIV prevention. However the impact of HCT on HIV acquisition has never been assessed among youth. We assess the impact of HCT on HIV acquisition among South African youth. DESIGN: Data came from an annual HIV survey for persons aged 15 years and over, nested within a socio-demographic household surveillance in a geographically defined area of KwaZulu-Natal. Within this population, we used data from 2006 to 2011 to construct a cohort of HIV-uninfected youth aged 15-24 years. METHODS: We compared youth who reported knowing their HIV status from HCT with those who reported not knowing their HIV status for time to HIV seroconversion using time-varying marginal structural Cox proportional hazards models. RESULTS: The cohort included 3959 HIV-uninfected youth, of whom 1167 (29%) reported HCT at baseline and an additional 1064 (27%) reported HCT during follow up. Youth experienced 248 seroconversions over 8536 person-years, an incidence rate of 2.91 per 100 person-years [95% confidence interval (CI) 2.56-3.28]. In crude analysis, HCT was not associated with HIV incidence (hazard ratio 1.02, 95% CI 0.79-1.31], but in marginal structural models weighted for risk factors, HCT was protective (hazard ratio 0.59, 95% CI 0.45-0.78). CONCLUSION: In this high-risk population, after accounting for differences in underlying HIV acquisition risk, HCT was associated with lower HIV incidence. HCT scale-up may have prevention benefits for HIV-uninfected youth.
目的：撒哈拉以南非洲地区年龄在 15-24 岁的青少年感染艾滋病毒的风险较高，迫切需要艾滋病毒预防干预措施。艾滋病毒咨询和检测（HCT）旨在促进艾滋病毒预防。然而，HCT 对青少年获得艾滋病毒的影响从未得到评估。我们评估了 HCT 对南非青年获得艾滋病毒的影响。
设计：数据来自于对年满 15 岁及以上人群进行的年度艾滋病毒调查，该调查嵌套在夸祖鲁-纳塔尔省一个地理位置明确的社会人口家庭监测中。在这一人群中，我们使用了 2006 年至 2011 年的数据，构建了一个由 15-24 岁的未感染艾滋病毒的青年组成的队列。
方法：我们使用时间变化的边际结构 Cox 比例风险模型比较了报告通过 HCT 了解自己艾滋病毒状况的青年与报告不知道自己艾滋病毒状况的青年发生艾滋病毒血清转换的时间。
结果：该队列包括 3959 名未感染艾滋病毒的青年，其中 1167 名（29%）在基线时报告进行了 HCT，另有 1064 名（27%）在随访期间报告进行了 HCT。在 8536 人年中，青年发生了 248 例血清转换，发病率为 2.91/100 人年[95%置信区间（CI）2.56-3.28]。在粗分析中，HCT 与艾滋病毒发病率无关（危险比 1.02，95%CI 0.79-1.31），但在针对危险因素进行边际结构模型加权后，HCT 具有保护作用（危险比 0.59，95%CI 0.45-0.78）。
结论：在这一高危人群中，在考虑到潜在的艾滋病毒感染风险差异后，HCT 与较低的艾滋病毒发病率相关。扩大 HCT 规模可能对未感染艾滋病毒的青年有预防益处。
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