Lépine Aurélia, Terris-Prestholt Fern, Vickerman Peter
London School of Hygiene and Tropical Medicine, Global Health and Development Department, London, WC1H 9SH, UK
London School of Hygiene and Tropical Medicine, Global Health and Development Department, London, WC1H 9SH, UK.
Health Policy Plan. 2015 Jun;30(5):579-92. doi: 10.1093/heapol/czu036. Epub 2014 Jun 6.
In this article we analyse the determinants of HIV testing among Nigerian couples using Demographic and Health Survey data set (2008). This study is motivated by the fact that although there is a strong willingness from the Nigerian Government to examine new HIV preventions approaches such as Pre-Exposure Prophylaxis for HIV (PrEP) and Treatment as Prevention (TasP) for HIV serodiscordant couples, the implementation of such policies would require the HIV status of each partner in the couple to be known. This is far to be achieved in the Nigerian context since in Nigeria only 6% of couples know their HIV status. In order to identify potential policies that are needed to increase HIV testing uptake, we use a three-level random intercept logistic model to separately explore the determinants of knowing HIV status among female and male partners. The use of the multilevel modelling allows including the unobserved heterogeneity at the village and state level that may affect HIV testing behaviours. Our results indicate that education, wealth, stigma, HIV knowledge and perceived risk are predictors of HIV testing among both partners while routine provider initiated testing appears to be very effective to increase HIV testing among women. The introduction of financial incentives as well as an increase in routine testing and home-based testing may be needed for large scale increase in HIV testing prior to the implementation of new HIV prevention technologies among discordant couples.
在本文中，我们利用人口与健康调查数据集（2008年）分析了尼日利亚夫妇中艾滋病毒检测的决定因素。这项研究的动机在于，尽管尼日利亚政府强烈希望研究新的艾滋病毒预防方法，如针对艾滋病毒血清学不一致夫妇的暴露前预防（PrEP）和治疗即预防（TasP），但实施此类政策需要了解夫妇中每一方的艾滋病毒感染状况。在尼日利亚的情况下，这一目标远未实现，因为在尼日利亚只有6%的夫妇知道自己的艾滋病毒感染状况。为了确定提高艾滋病毒检测接受率所需的潜在政策，我们使用三级随机截距逻辑模型分别探讨女性和男性伴侣中了解艾滋病毒感染状况的决定因素。使用多层次模型可以纳入可能影响艾滋病毒检测行为的村庄和州层面未观察到的异质性。我们的结果表明，教育、财富、耻辱感、艾滋病毒知识和感知风险是双方艾滋病毒检测的预测因素，而常规由医疗服务提供者发起的检测似乎对增加女性的艾滋病毒检测非常有效。在对血清学不一致的夫妇实施新的艾滋病毒预防技术之前，可能需要引入经济激励措施以及增加常规检测和家庭检测，以大幅提高艾滋病毒检测率。
