HIV诊断后加速HIV治疗及抗逆转录病毒治疗启动的策略：一项随机试验

Strategies to Accelerate HIV Care and Antiretroviral Therapy Initiation After HIV Diagnosis: A Randomized Trial.

作者信息

Hoffmann Christopher J, Mabuto Tonderai, Ginindza Sibuse, Fielding Katherine L, Kubeka Griffths, Dowdy David W, Churchyard Gavin J, Charalambous Salome

机构信息

*Department of Medicine, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD; †The Aurum Institute, Johannesburg, South Africa; ‡The University of the Witwatersrand School of Public Health, Johannesburg, South Africa; and §Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.

出版信息

J Acquir Immune Defic Syndr. 2017 Aug 15;75(5):540-547. doi: 10.1097/QAI.0000000000001428.

DOI:10.1097/QAI.0000000000001428

PMID:28471840

Abstract

OBJECTIVE

Determine the effectiveness of strategies to increase linkage to care after testing HIV positive at mobile HIV testing in South Africa.

DESIGN

Unmasked randomized controlled trial.

METHODS

Recruitment of adults testing HIV positive and not currently in HIV care occurred at 7 mobile HIV counseling and testing units in urban, periurban, and rural South Africa with those consenting randomized 1:1:1:1 into 1 of 4 arms. Three strategies were compared with standard of care (SOC): point-of-care CD4 count testing (POC CD4), POC CD4 plus longitudinal strengths-based counseling (care facilitation; CF), and POC CD4 plus transport reimbursement (transport). Participants were followed up telephonically and through clinic records and analyzed with an intention-to-treat analysis.

RESULTS

From March 2013 to October 2014, 2558 participants were enrolled, of whom 160 were excluded postrandomization. Compared with the SOC arm where 298 (50%) reported having entered care, linkage to care was 319 (52%) for POC CD4, hazard ratio (HR) 1.0 [95% confidence interval (CI): 0.89 to 1.2, P = 0.6]; 331 (55%) for CF, HR: 1.1 (95% CI: 0.84 to 1.3, P = 0.2); and 291 (49%) for transport, HR 0.97 (95% CI: 0.83 to 1.1, P = 0.7). Linkage to care verified with clinical records that occurred for 172 (29%) in the SOC arm; 187 (31%) in the POC CD4 arm, HR: 1.0 (95% CI: 0.86 to 1.3, P = 0.6); 225 (38%) in the CF arm, HR: 1.4 (95% CI: 1.1 to 1.7, P = 0.001); and 180 (31%) in the transport arm, HR: 1.1 (95% CI: 0.88 to 1.3, P = 0.5).

CONCLUSIONS

CF improved verified linkage to care from 29% to 38%.

摘要

目的

确定在南非移动艾滋病毒检测中，检测出艾滋病毒呈阳性后增加与护理联系的策略的有效性。

设计

非盲随机对照试验。

方法

在南非城市、城郊和农村的7个移动艾滋病毒咨询和检测单位招募艾滋病毒检测呈阳性且目前未接受艾滋病毒护理的成年人，同意参与的人按1:1:1:1随机分为4组中的1组。将三种策略与标准护理（SOC）进行比较：即时检测CD4计数检测（POC CD4）、POC CD4加上基于优势的纵向咨询（护理促进；CF）以及POC CD4加上交通费用报销（交通）。通过电话随访参与者并查阅临床记录，并采用意向性分析进行分析。

结果

2013年3月至2014年10月，共招募了2558名参与者，其中160名在随机分组后被排除。与SOC组中298人（50%）报告已接受护理相比，POC CD4组的护理联系率为319人（52%），风险比（HR）为1.0[95%置信区间（CI）：0.89至1.2，P = 0.6]；CF组为331人（55%），HR：1.1（95%CI：0.84至1.3，P = 0.2）；交通组为291人（49%），HR为0.97（95%CI：0.83至1.1，P = 0.7）。通过临床记录核实的护理联系情况，SOC组为172人（29%）；POC CD4组为187人（31%），HR：1.0（95%CI：0.86至1.3，P = 0.6）；CF组为225人（38%），HR：1.4（95%CI：1.1至1.7，P = 0.001）；交通组为180人（31%），HR：1.1（95%CI：0.88至1.3，P = 0.5）。