*Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA; †Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; and ‡HIV/AIDS Tuberculosis Global Program, Program for Appropriate Technology in Health (PATH), Washington, DC.
J Acquir Immune Defic Syndr. 2014 May 1;66(1):e1-7. doi: 10.1097/QAI.0000000000000076.
We describe predictors of first follow-up testing for concordant negative and discordant couples seeking joint voluntary HIV counseling and testing in Ndola, Zambia, where cohabiting couples account for an estimated two-thirds of incident HIV infections.
Demographic and serostatus data were collected from couples' voluntary HIV testing and counseling and follow-up testing services implemented in government clinics. We calculated follow-up testing rates by serostatus and compared rates before and after the introduction of a Good Health Package (GHP).
The follow-up testing rate from May 2011 to December 2012 was 12.2% for concordant negative (M-F-) couples and 24.5% for discordant (M+F- or M-F+) couples. Significant predictors of follow-up testing in multivariate analyses included increasing age of the man [adjusted odds ratio (aOR) = 1.02 per year] and the woman (aOR = 1.02 per year), and either partner being HIV+ (aOR = 2.57 for HIV+ man, aOR = 1.89 for HIV+ woman). The man (aOR = 1.29) and the couple (aOR = 1.22) having been previously tested for HIV were predictive of follow-up testing among concordant negative couples. Introduction of a GHP increased follow-up testing among discordant (aOR = 2.93) and concordant negative (aOR = 2.06) couples.
A low-cost GHP, including prevention, screening, and treatment for common causes of morbidity and mortality resulted in increased follow-up testing rates among HIV discordant and concordant negative couples. Overall follow-up testing rates remain low, and efforts to increase these rates are necessary to ensure linkage to combination prevention, reduce HIV transmission within couples, and identify seroconversions promptly. Further investigation of low-cost sustainable incentives and other factors influencing follow-up HIV testing for couples is needed.
我们描述了在赞比亚恩多拉，寻求联合自愿艾滋病毒咨询和检测的一致性阴性和不一致性夫妇中，首次随访检测的预测因素。在那里，同居夫妇估计占艾滋病毒新感染病例的三分之二。
从夫妇自愿艾滋病毒检测和咨询以及在政府诊所实施的后续检测服务中收集人口统计学和血清学数据。我们按血清学状况计算了随访检测率，并比较了在引入良好健康一揽子计划（GHP）前后的检测率。
2011 年 5 月至 2012 年 12 月，一致性阴性（M-F-）夫妇的随访检测率为 12.2%，不一致（M+F-或 M-F+）夫妇的随访检测率为 24.5%。多变量分析中的显著随访检测预测因素包括男方年龄增加[调整后的优势比（aOR）=每年 1.02]和女方年龄增加[aOR = 1.02 岁]，以及任一伴侣 HIV 阳性[aOR = HIV 阳性男性 2.57，aOR = HIV 阳性女性 1.89]。男方（aOR = 1.29）和夫妇（aOR = 1.22）以前进行过艾滋病毒检测，这预示着一致性阴性夫妇的随访检测。引入 GHP 增加了不一致性（aOR = 2.93）和一致性阴性（aOR = 2.06）夫妇的随访检测率。
低成本的 GHP 包括对常见病因的预防、筛查和治疗，这导致了 HIV 不一致和一致性阴性夫妇随访检测率的增加。总体随访检测率仍然较低，有必要努力提高这些比率，以确保夫妇能够及时接受综合预防、减少夫妇之间的艾滋病毒传播并迅速发现血清转换。需要进一步研究低成本可持续激励措施和其他影响夫妇 HIV 随访检测的因素。
