在卢旺达的诊所中，由医疗服务提供者发起的艾滋病毒检测与咨询是否会带来更高的艾滋病毒检测率和艾滋病毒病例发现率？
Does provider-initiated HIV testing and counselling lead to higher HIV testing rate and HIV case finding in Rwandan clinics?
作者信息
Kayigamba Felix R, Van Santen Daniëla, Bakker Mirjam I, Lammers Judith, Mugisha Veronicah, Bagiruwigize Emmanuel, De Naeyer Ludwig, Asiimwe Anita, Schim Van Der Loeff Maarten F
机构信息
INTERACT, Kigali, Rwanda.
KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands.
出版信息
BMC Infect Dis. 2016 Jan 25;16:26. doi: 10.1186/s12879-016-1355-z.
BACKGROUND
Provider-initiated HIV testing and counselling (PITC) is promoted as a means to increase HIV case finding. We assessed the effectiveness of PITC to increase HIV testing rate and HIV case finding among outpatients in Rwandan health facilities (HF).
METHODS
PITC was introduced in six HFs in 2009-2010. HIV testing rate and case finding were compared between phase 1 (pre-PITC) and phase 3 (PITC period) for outpatient-department (OPD) attendees only, and for OPD and voluntary counseling & testing (VCT) departments combined.
RESULTS
Out of 26,367 adult OPD attendees in phase 1, 4.7% were tested and out of 29,864 attendees in phase 3, 17.0% were tested (p < 0.001). The proportion of HIV cases diagnosed was 0.25% (67/26,367) in phase 1 and 0.46% (136/29864) in phase 3 (p < 0.001). In multivariable analysis, both testing rate and case finding were significantly higher in phase 3 for OPD attendees. In phase 1 most of the HIV testing was done in VCT departments rather than at the OPD (78.6% vs 21.4% respectively); in phase 3 this was reversed (40.0% vs 60.0%; p < 0.001). In a combined analysis of VCT and OPD attendees, testing rate increased from 18.7% in phase 1 to 25.4% in phase 3, but case finding did not increase. In multivariable analysis, testing rate was significantly higher in phase 3 (OR 1.67; 95% CI 1.60-1.73), but case finding remained stable (OR 1.09; 95% CI 0.93-1.27).
CONCLUSION
PITC led to a shift of HIV testing from VCT department to the OPD, a higher testing rate, but no additional HIV case finding.
背景
医疗机构主动提供的艾滋病毒检测与咨询服务（PITC）被视作一种增加艾滋病毒病例发现数的手段。我们评估了PITC在提高卢旺达医疗机构（HF）门诊患者艾滋病毒检测率及病例发现数方面的有效性。
方法
2009 - 2010年期间，在6家医疗机构引入了PITC。仅针对门诊部门（OPD）的就诊者，以及综合门诊和自愿咨询检测（VCT）部门，比较了第1阶段（PITC实施前）和第3阶段（PITC实施期间）的艾滋病毒检测率及病例发现数。
结果
在第1阶段的26367名成年OPD就诊者中，4.7%接受了检测；在第3阶段的29864名就诊者中，17.0%接受了检测（p < 0.001）。第1阶段艾滋病毒确诊病例的比例为0.25%（67/26367），第3阶段为0.46%（136/29864）（p < 0.001）。在多变量分析中，第3阶段OPD就诊者的检测率和病例发现数均显著更高。在第1阶段，大多数艾滋病毒检测是在VCT部门而非OPD进行（分别为78.6%和21.4%）；在第3阶段，情况相反（40.0%对60.0%；p < 0.001）。在对VCT和OPD就诊者的综合分析中，检测率从第1阶段的18.7%增至第3阶段的25.4%，但病例发现数并未增加。在多变量分析中，第3阶段的检测率显著更高（比值比1.67；95%置信区间1.60 - 1.73），但病例发现数保持稳定（比值比1.09；95%置信区间0.93 - 1.27）。
结论
PITC导致艾滋病毒检测从VCT部门转移至OPD，检测率更高，但并未发现更多艾滋病毒病例。
Zotero 插件