Parker Lucy Anne, Jobanputra Kiran, Rusike Lorraine, Mazibuko Sikhathele, Okello Velephi, Kerschberger Bernhard, Jouquet Guillaume, Cyr Joanne, Teck Roger
Médecins Sans Frontières, Geneva, Switzerland.
Médecins Fans Frontières, Nhlangano, Swaziland.
Trop Med Int Health. 2015 Jul;20(7):893-902. doi: 10.1111/tmi.12501. Epub 2015 Apr 2.
To evaluate the feasibility (population reached, costs) and effectiveness (positivity rates, linkage to care) of two strategies of community-based HIV testing and counselling (HTC) in rural Swaziland.
Strategies used were mobile HTC (MHTC) and home-based HTC (HBHTC). Information on age, sex, previous testing and HIV results was obtained from routine HTC records. A consecutive series of individuals testing HIV-positive were followed up for 6 months from the test date to assess linkage to care.
A total of 9 060 people were tested: 2 034 through MHTC and 7 026 through HBHTC. A higher proportion of children and adolescents (<20 years) were tested through HBHTC than MHTC (57% vs. 17%; P < 0.001). MHTC reached a higher proportion of adult men than HBHTC (42% vs. 39%; P = 0.015). Of 398 HIV-positive individuals, only 135 (34%) were enrolled in HIV care within 6 months. Of 42 individuals eligible for antiretroviral therapy, 22 (52%) started treatment within 6 months. Linkage to care was lowest among people who had tested previously and those aged 20-40 years. HBHTC was 50% cheaper (US$11 per person tested; $797 per individual enrolled in HIV care) than MHTC ($24 and $1698, respectively).
In this high HIV prevalence setting, a community-based testing programme achieved high uptake of testing and appears to be an effective and affordable way to encourage large numbers of people to learn their HIV status (particularly underserved populations such as men and young people). However, for community HTC to impact mortality and incidence, strategies need to be implemented to ensure people testing HIV-positive in the community are linked to HIV care.
评估斯威士兰农村地区两种基于社区的HIV检测与咨询（HTC）策略的可行性（覆盖人群、成本）和有效性（阳性率、与治疗的关联）。
采用的策略为流动HTC（MHTC）和居家HTC（HBHTC）。从常规HTC记录中获取年龄、性别、既往检测情况及HIV检测结果等信息。对一系列连续检测出HIV阳性的个体，从检测日期起随访6个月，以评估其与治疗的关联。
共检测了9060人：通过MHTC检测2034人，通过HBHTC检测7026人。通过HBHTC检测的儿童和青少年（<20岁）比例高于MHTC（57%对17%；P<0.001）。MHTC检测的成年男性比例高于HBHTC（42%对39%；P = 0.015）。在398例HIV阳性个体中，仅135例（34%）在6个月内进入HIV治疗程序。在42例符合抗逆转录病毒治疗条件的个体中，22例（52%）在6个月内开始治疗。既往检测过的人群以及20 - 40岁人群与治疗的关联最低。HBHTC比MHTC便宜50%（每人检测成本11美元；每例进入HIV治疗程序的个体成本797美元），而MHTC分别为24美元和1698美元。
在这个HIV高流行地区，基于社区的检测项目实现了高检测率，似乎是鼓励大量人群了解自身HIV感染状况（特别是男性和年轻人等服务不足人群）的有效且经济的方式。然而，为使社区HTC对死亡率和发病率产生影响，需要实施策略以确保社区中检测出HIV阳性的人群能获得HIV治疗。
