Pathmanathan Ishani, Lederer Philip, Shiraishi Ray W, Wadonda-Kabondo Nellie, Date Anand, Matatiyo Blackson, Dokubo E Kainne
Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
Epidemic Intelligence Service, CDC, Atlanta, Georgia.
Open Forum Infect Dis. 2016 Dec 15;4(1):ofw231. doi: 10.1093/ofid/ofw231. eCollection 2017 Winter.
Awareness of human immunodeficiency virus (HIV) status among all people with HIV is critical for epidemic control. We aimed to assess accurate knowledge of HIV status, defined as concordance with serosurvey test results from the 2010 Malawi Demographic Health Survey (MDHS), and to identify risk factors for seropositivity among adults (aged 15-49) reporting a most recently negative test within 12 months.
Data were analyzed from the 2010 MDHS. A logistic regression model was constructed to determine factors independently associated with HIV seropositivity after a recently negative test. All analyses controlled for the survey's complex design.
A total of 11 649 adults tested for HIV during this MDHS reported ever being sexually active. Among these, HIV seroprevalence was 12.0%, but only 61.7% had accurate knowledge of their status. Forty percent (40.3%; 95% confidence interval [CI], 36.8-43.8) of seropositive respondents reported a most recently negative test. Of those reporting that this negative test was within 12 months (n = 3630), seroprevalence was 7.2% for women (95% CI, 5.7-9.2), 5.2% for men (95% CI, 3.9-6.9), higher in the South, and higher in rural areas for men. Women with higher education and men in the richest quintile were at higher risk. More than 1 lifetime union was significantly associated with recent HIV infection, whereas never being married was significantly protective.
Self-reported HIV status based on prior test results can underestimate seroprevalence. These results highlight the need for posttest risk assessment and support for people who test negative for HIV and repeat testing in people at high risk for HIV infection.
了解所有艾滋病毒感染者的艾滋病毒感染状况对于疫情控制至关重要。我们旨在评估对艾滋病毒感染状况的准确知晓情况（定义为与2010年马拉维人口与健康调查（MDHS）的血清学调查结果一致），并确定在过去12个月内报告最近一次检测结果为阴性的15至49岁成年人中血清学阳性的危险因素。
对2010年MDHS的数据进行分析。构建逻辑回归模型以确定与最近一次检测结果为阴性后艾滋病毒血清学阳性独立相关的因素。所有分析均考虑了调查的复杂设计。
在本次MDHS期间接受艾滋病毒检测的11649名成年人中，报告有过性活动。其中，艾滋病毒血清流行率为12.0%，但只有61.7%的人准确知晓自己的感染状况。40%（40.3%；95%置信区间[CI]，36.8 - 43.8）的血清学阳性受访者报告最近一次检测结果为阴性。在那些报告该阴性检测结果在过去12个月内的人群中（n = 3630），女性血清流行率为7.2%（95%CI，5.7 - 9.2），男性为5.2%（95%CI，3.9 - 6.9），南部地区较高，男性在农村地区的血清流行率更高。受过高等教育的女性和最富裕五分之一人群中的男性感染风险更高。有多个性伴侣与近期艾滋病毒感染显著相关，而从未结婚则具有显著的保护作用。
根据既往检测结果自我报告的艾滋病毒感染状况可能低估血清流行率。这些结果凸显了对艾滋病毒检测呈阴性者进行检测后风险评估和支持的必要性，以及对艾滋病毒感染高危人群进行重复检测的必要性。
