Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
PLoS One. 2013 Nov 13;8(11):e80017. doi: 10.1371/journal.pone.0080017. eCollection 2013.
HIV counseling and testing may serve as an entry point for non-communicable disease screening.
To determine the yield of newly-diagnosed HIV, tuberculosis (TB) symptoms, diabetes and hypertension, and to assess CD4 count testing, linkage to care as well as correlates of linkage and barriers to care from a mobile testing unit.
A mobile unit provided screening for HIV, TB symptoms, diabetes and hypertension in Cape Town, South Africa between March 2010 and September 2011. The yield of newly-diagnosed cases of these conditions was measured and clients were followed-up between January and November 2011 to assess linkage. Linkage to care was defined as accessing care within one, three or six months post-HIV diagnosis (dependent on CD4 count) and one month post-diagnosis for other conditions. Clinical and socio-demographic correlates of linkage to care were evaluated using Poisson regression and barriers to care were determined.
Of 9,806 clients screened, the yield of new diagnoses was: HIV (5.5%), TB suspects (10.1%), diabetes (0.8%) and hypertension (58.1%). Linkage to care for HIV-infected clients, TB suspects, diabetics and hypertensives was: 51.3%, 56.7%, 74.1% and 50.0%. Only disclosure of HIV-positive status to family members or partners (RR=2.6, 95% CI: 1.04-6.3, p=0.04) was independently associated with linkage to HIV care. The main barrier to care reported by all groups was lack of time to access a clinic.
Screening for HIV, TB symptoms and hypertension at mobile units in South Africa has a high yield but inadequate linkage. After-hours and weekend clinics may overcome a major barrier to accessing care.
艾滋病咨询和检测可作为非传染性疾病筛查的切入点。
确定新诊断的艾滋病、结核病（TB）症状、糖尿病和高血压的检出率，并评估移动检测单元的 CD4 计数检测、与护理的衔接情况以及与衔接相关的因素和护理障碍。
2010 年 3 月至 2011 年 9 月，在南非开普敦的一个移动检测单元中对 HIV、TB 症状、糖尿病和高血压进行了筛查。测量了这些疾病新诊断病例的检出率，并在 2011 年 1 月至 11 月期间对患者进行了随访，以评估衔接情况。将与护理的衔接定义为在 HIV 诊断后（根据 CD4 计数而定）的 1、3 或 6 个月内以及其他疾病诊断后 1 个月内获得护理。使用泊松回归评估与护理衔接相关的临床和社会人口统计学因素，并确定护理障碍。
在筛查的 9806 名患者中，新诊断的检出率为：HIV（5.5%）、疑似结核病（10.1%）、糖尿病（0.8%）和高血压（58.1%）。HIV 感染者、疑似结核病患者、糖尿病患者和高血压患者与护理的衔接率分别为：51.3%、56.7%、74.1%和 50.0%。仅向家庭成员或伴侣透露 HIV 阳性状态（RR=2.6，95%CI：1.04-6.3，p=0.04）与与 HIV 护理的衔接相关。所有组报告的主要护理障碍是缺乏去诊所的时间。
在南非的移动单元中筛查 HIV、TB 症状和高血压的检出率很高，但衔接率不足。提供非工作时间和周末诊所可能会克服获得护理的一个主要障碍。
