Maman D, Ben-Farhat J, Chilima B, Masiku C, Salumu L, Ford N, Mendiharat P, Szumilin E, Masson S, Etard J F
Epicentre, Médecins Sans Frontières, Paris, France.
Community Health Sciences Unit, Malawi Ministry of Health, Lilongwe, Malawi.
Trop Med Int Health. 2016 Nov;21(11):1442-1451. doi: 10.1111/tmi.12772. Epub 2016 Oct 7.
HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi.
Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care.
Of 8277 individuals eligible for the survey, 7270 (87.8%) participated and were tested for HIV. The overall HIV prevalence was 17.0%. Among HIV-positive participants, 77.0% knew their status and 72.8% were in care. Women (adjusted odds ratio [aOR] 6.5, 95% CI 3.2-13.1) and older participants (40-59 vs. 15-29 years, aOR 10.1, 95% CI 4.0-25.9) were more likely to be aware of their positive status. Of those newly diagnosed, 47.5% were linked to care within 3 months. Linkage to care was higher among older participants (40-59 vs. 15-29, adjusted hazard ratio [aHR] 3.39, 95% CI 1.83-6.26), women (aHR 1.73, 95% CI 1.12-2.67) and those eligible for ART (aHR 1.61, 95% CI 1.03-2.52).
In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.
在非洲，艾滋病毒诊断及与治疗的衔接是实现联合国艾滋病规划署90-90-90目标的主要障碍。我们评估了马拉维奇拉祖卢区调查参与者中艾滋病毒阳性状态知晓情况及与治疗的衔接情况。
在2013年2月至5月对15至59岁人群进行的基于人群的调查中开展嵌套队列研究。参与者在家中接受访谈并进行艾滋病毒检测（若检测出艾滋病毒阳性则检测CD4）。采用多变量回归分析来确定在调查前知晓艾滋病毒阳性状态以及随后与治疗衔接的相关因素。
在8277名符合调查条件的个体中，7270人（87.8%）参与调查并接受了艾滋病毒检测。总体艾滋病毒感染率为17.0%。在艾滋病毒阳性参与者中，77.0%知晓自己的状态，72.8%接受了治疗。女性（调整优势比[aOR] 6.5，95%置信区间[CI] 3.2 - 13.1）和年龄较大的参与者（40 - 59岁与15 - 29岁相比，aOR 10.1，95% CI 4.0 - 25.9）更有可能知晓自己的阳性状态。在新诊断出的患者中，47.5%在3个月内与治疗机构建立了联系。年龄较大的参与者（40 - 59岁与15 - 29岁相比，调整风险比[aHR] 3.39，95% CI 1.83 - 6.26）、女性（aHR 1.73，95% CI 1.12 - 2.67）以及符合抗逆转录病毒治疗条件的患者（aHR 1.61，95% CI 1.03 - 2.52）与治疗的衔接情况更好。
在艾滋病毒知晓率较高的地区，居家检测仍是诊断并与治疗机构衔接的有效策略。男性被诊断出感染艾滋病毒的可能性较小，且确诊后与治疗机构衔接的可能性也较小，这凸显了为实现90-90-90目标而关注性别的必要性。
