Bassett I V, Regan S, Luthuli P, Mbonambi H, Bearnot B, Pendleton A, Robine M, Mukuvisi D, Thulare H, Walensky R P, Freedberg K A, Losina E, Mhlongo B
Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Center for AIDS Research, Harvard University, Boston, MA, USA.
HIV Med. 2014 Jul;15(6):367-72. doi: 10.1111/hiv.12115. Epub 2013 Nov 19.
The aim of the study was to assess HIV prevalence, disease stage and linkage to HIV care following diagnosis at a mobile HIV testing unit, compared with results for clinic-based testing, in a Durban township.
This was a prospective cohort study. We enrolled adults presenting for HIV testing at a community-based mobile testing unit (mobile testers) and at an HIV clinic (clinic testers) serving the same area. Testers diagnosed with HIV infection, regardless of testing site, were offered immediate CD4 testing and instructed to retrieve results at the clinic. We assessed rates of linkage to care, defined as CD4 result retrieval within 90 days of HIV diagnosis and/or completion of antiretroviral therapy (ART) literacy training, for mobile vs. clinic testers.
From July to November 2011, 6957 subjects were HIV tested (4703 mobile and 2254 clinic); 55% were female. Mobile testers had a lower HIV prevalence than clinic testers (10% vs. 36%, respectively), were younger (median 23 vs. 27 years, respectively) and were more likely to live >5 km or >30 min from the clinic (64% vs. 40%, respectively; all P < 0.001). Mobile testers were less likely to undergo CD4 testing (33% vs. 83%, respectively) but more likely to have higher CD4 counts [median (interquartile range) 416 (287-587) cells/μL vs. 285 (136-482) cells/μL, respectively] than clinic testers (both P < 0.001). Of those who tested HIV positive, 10% of mobile testers linked to care, vs. 72% of clinic testers (P < 0.001).
Mobile HIV testing reaches people who are younger, who are more geographically remote, and who have earlier disease compared with clinic-based testing. Fewer mobile testers underwent CD4 testing and linked to HIV care. Enhancing linkage efforts may improve the impact of mobile testing for those with early HIV disease.
本研究旨在评估德班一个城镇中，与基于诊所的检测结果相比，移动艾滋病毒检测单位诊断后的艾滋病毒流行率、疾病阶段及与艾滋病毒治疗的关联情况。
这是一项前瞻性队列研究。我们纳入了在社区移动检测单位（移动检测者）和为同一地区服务的艾滋病毒诊所（诊所检测者）进行艾滋病毒检测的成年人。无论检测地点如何，被诊断为艾滋病毒感染的检测者都接受了即时CD4检测，并被指示在诊所获取检测结果。我们评估了移动检测者与诊所检测者与治疗的关联率，定义为在艾滋病毒诊断后90天内获取CD4检测结果和/或完成抗逆转录病毒治疗（ART）知识培训。
2011年7月至11月，6957名受试者接受了艾滋病毒检测（4703名移动检测者和2254名诊所检测者）；55%为女性。移动检测者的艾滋病毒流行率低于诊所检测者（分别为10%和36%），年龄更小（中位数分别为23岁和27岁），且居住在距离诊所超过5公里或30分钟路程以外的可能性更大（分别为64%和40%；所有P<0.001）。移动检测者接受CD4检测的可能性较小（分别为33%和83%），但CD4计数高于诊所检测者[中位数（四分位间距）分别为416（287-587）个细胞/微升和285（136-482）个细胞/微升]（两者P<0.001）。在艾滋病毒检测呈阳性的人中，10%的移动检测者与治疗建立了关联，而诊所检测者为72%（P<0.001）。
与基于诊所的检测相比，移动艾滋病毒检测覆盖了更年轻、地理位置更偏远且疾病更早发的人群。接受CD4检测并与艾滋病毒治疗建立关联的移动检测者较少。加强关联工作可能会提高移动检测对早期艾滋病毒疾病患者的影响。
