Ruzagira Eugene, Baisley Kathy, Kamali Anatoli, Biraro Samuel, Grosskurth Heiner
London School of Hygiene and Tropical Medicine, London, UK.
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
Trop Med Int Health. 2017 Jul;22(7):807-821. doi: 10.1111/tmi.12888. Epub 2017 May 22.
Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA.
Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines.
A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8-9.8%] to 99.1% (95% CI, 96.9-99.9%). Linkage was generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1-21.8) to 77.8% (95% CI, 40.0-97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36-57.9%) to 94.9% (95% CI, 91.3-97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions.
Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials.
基于家庭的艾滋病毒咨询和检测（HBHCT）有潜力提高撒哈拉以南非洲（SSA）地区的艾滋病毒检测接受率，但关于HBHCT后与艾滋病毒治疗衔接的数据很少。我们对SSA地区HBHCT后与治疗衔接情况进行了系统评价。
检索了五个数据库，查找2000年1月1日至2016年8月19日期间发表的研究，这些研究报告了通过HBHCT新确诊艾滋病毒感染的成年人与治疗衔接情况。对符合条件的研究进行了审查，评估偏倚风险，并使用PRISMA指南总结研究结果。
来自六个国家的14项研究符合纳入标准；除常规转诊外，九项研究还采用了特定策略（即时护理CD4细胞计数检测、随访咨询、提供前往诊所的交通费用以及咨询师协助艾滋病毒诊所就诊）以促进与治疗的衔接。确定衔接情况的时间间隔为HBHCT后1周-12个月。衔接率从8.2%[95%置信区间（CI），6.8-9.8%]到99.1%（95%CI，96.9-99.9%）不等。如果HBHCT后仅进行转诊，衔接率通常较低（<33%），如果采用额外策略则较高（>80%）。只有一项研究通过随机试验评估衔接情况。五项研究有关于复方新诺明（CTX）预防的数据，12项研究有关于抗逆转录病毒治疗（ART）资格和启动的数据。符合条件者中CTX的使用率从0%到100%不等。符合ART条件者的比例从16.5%（95%CI，12.1-21.8）到77.8%（95%CI，40.0-97.2）不等。符合条件者中ART启动率从14.3%（95%CI，0.36-57.9%）到94.9%（95%CI，91.3-97.4%）不等。额外的衔接策略虽然似乎增加了衔接率，但与CTX和/或ART的更高使用率无关。大多数研究易受结果确定偏倚风险的影响。由于研究在设计、背景和关键变量定义方面存在异质性，未进行汇总分析。
SSA地区只有少数研究调查了通过HBHCT新诊断艾滋病毒感染成年人与治疗的衔接情况。常规转诊后衔接率往往较低，但采用额外干预措施促进衔接时衔接率较高。衔接策略的有效性应通过随机对照试验来证实。
