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坦桑尼亚姆贝亚通过外展和基于机构的艾滋病毒检测模式进行检测的新诊断艾滋病毒阳性个体的护理联系：一项前瞻性混合方法队列研究。

Linkage into care among newly diagnosed HIV-positive individuals tested through outreach and facility-based HIV testing models in Mbeya, Tanzania: a prospective mixed-method cohort study.

作者信息

Sanga Erica Samson, Lerebo Wondwossen, Mushi Adiel K, Clowes Petra, Olomi Willyhelmina, Maboko Leonard, Zarowsky Christina

机构信息

NIMR-Mbeya Medical Research Centre (MMRC), Mbeya, Tanzania.

School of Public Health, University of Western Cape, Cape Town, South Africa.

出版信息

BMJ Open. 2017 Apr 12;7(4):e013733. doi: 10.1136/bmjopen-2016-013733.

DOI:10.1136/bmjopen-2016-013733
PMID:28404611
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5541440/
Abstract

OBJECTIVE: Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV-positive individuals tested at mobile/outreach versus public health facility-based services within the first 6 months of HIV diagnosis. SETTING: Rural communities in four districts of Mbeya Region, Tanzania. PARTICIPANTS: A total of 1012 newly diagnosed HIV-positive adults from 16 testing facilities were enrolled into a two-armed cohort and followed for 6 months between August 2014 and July 2015. 840 (83%) participants completed the study. MAIN OUTCOME MEASURES: We compared the ratios and time variance in linkage to care using the Kaplan-Meier estimator and Log rank tests. Cox proportional hazards regression models to evaluate factors associated with time variance in linkage. RESULTS: At the end of 6 months, 78% of all respondents had linked into care, with differences across testing models. 84% (CI 81% to 87%, n=512) of individuals tested at facility-based site were linked to care compared to 69% (CI 65% to 74%, n=281) of individuals tested at mobile/outreach. The median time to linkage was 1 day (IQR: 1-7.5) for facility-based site and 6 days (IQR: 3-11) for mobile/outreach sites. Participants tested at facility-based site were 78% more likely to link than those tested at mobile/outreach when other variables were controlled (AHR=1.78; 95% CI 1.52 to 2.07). HIV status disclosure to family/relatives was significantly associated with linkage to care (AHR=2.64; 95% CI 2.05 to 3.39). CONCLUSIONS: Linkage to care after testing HIV positive in rural Tanzania has increased markedly since 2014, across testing models. Individuals tested at facility-based sites linked in significantly higher proportion and modestly sooner than mobile/outreach tested individuals. Mobile/outreach testing models bring HIV testing services closer to people. Strategies to improve linkage from mobile/outreach models are needed.

摘要

目的：获得医疗服务是艾滋病毒检测与艾滋病毒治疗、护理及支持之间的桥梁。在坦桑尼亚，流动检测旨在解决历来检测率较低的问题。据报告，2009年获得医疗服务的比例为14%，2014年为28%。本研究比较了在艾滋病毒诊断后的头6个月内，在流动/外展检测点和基于公共卫生机构的服务中接受检测的艾滋病毒呈阳性个体获得医疗服务的情况。 背景：坦桑尼亚姆贝亚地区四个区的农村社区。 参与者：来自16个检测机构的总共1012名新诊断出的艾滋病毒呈阳性成年人被纳入一个双臂队列，并在2014年8月至2015年7月期间随访6个月。840名（83%）参与者完成了研究。 主要观察指标：我们使用Kaplan-Meier估计器和对数秩检验比较了获得医疗服务的比例和时间差异。使用Cox比例风险回归模型评估与获得医疗服务时间差异相关的因素。 结果：在6个月末，所有受访者中有78%获得了医疗服务，不同检测模式之间存在差异。在基于机构的检测点接受检测的个体中，84%（CI 81%至87%，n = 512）获得了医疗服务，而在流动/外展检测点接受检测的个体中这一比例为69%（CI 65%至74%，n = 281）。基于机构检测点的中位获得医疗服务时间为1天（IQR：1 - 7.5），流动/外展检测点为6天（IQR：3 - 11）。在控制其他变量后，在基于机构检测点接受检测的参与者获得医疗服务的可能性比在流动/外展检测点接受检测的参与者高78%（AHR = 1.78；95% CI 1.52至2.07）。向家人/亲属披露艾滋病毒感染状况与获得医疗服务显著相关（AHR = 2.64；95% CI 2.05至3.39）。 结论：自2014年以来，在坦桑尼亚农村地区，艾滋病毒检测呈阳性后获得医疗服务的情况在所有检测模式中都有显著增加。在基于机构检测点接受检测的个体获得医疗服务的比例明显更高，且比在流动/外展检测点接受检测的个体稍早一些。流动/外展检测模式使艾滋病毒检测服务更贴近人群。需要采取策略来改善流动/外展检测模式下的获得医疗服务情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b03a/5541440/4b1555545484/bmjopen-2016-013733f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b03a/5541440/3819cc33ddf4/bmjopen-2016-013733f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b03a/5541440/4b1555545484/bmjopen-2016-013733f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b03a/5541440/3819cc33ddf4/bmjopen-2016-013733f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b03a/5541440/4b1555545484/bmjopen-2016-013733f02.jpg

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本文引用的文献

[1]
Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya.

BMC Public Health. 2016-5-4

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Linkage to care following a home-based HIV counselling and testing intervention in rural South Africa.

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BMC Infect Dis. 2014-10-15

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PLoS Med. 2014-9-16

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