Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Baltimore City Health Department, Baltimore, Maryland, USA.
Sex Transm Infect. 2018 Feb;94(1):37-39. doi: 10.1136/sextrans-2017-053104. Epub 2017 Sep 12.
Many individuals with HIV in the USA are unaware of their diagnosis, and therefore cannot be engaged in treatment services, have worse clinical outcomes and are more likely to transmit HIV to others. Mobile van testing may increase HIV testing and diagnosis. Our objective was to characterise risk factors for HIV seroconversion among individuals using mobile van testing.
A case cohort study (n=543) was conducted within an HIV surveillance dataset of mobile van testing users with at least two HIV tests between September 2004 and August 2009 in Baltimore, Maryland. A subcohort (n=423) was randomly selected; all additional cases were added from the parent cohort. Cases (n=122 total, two from random subcohort) had documented seroconversion at the follow-up visit. A unique aspect of the analysis was use of Department of Corrections data to document incarceration between the times of initial and subsequent testing. Multivariate Cox proportional hazards models were used to compare HIV transmission risk factors between individuals who seroconverted and those who did not.
One hundred and twenty-two HIV seroconversions occurred among 8756 individuals (1.4%), a rate higher than that in Baltimore City Health Department's STD Clinic clients (1%). Increased HIV seroconversion risk was associated with men who have sex with men (MSM) (HR 32.76, 95% CI 5.62 to 191.12), sex with an HIV positive partner (HR 70.2, 95% CI 9.58 to 514.89), and intravenous drug use (IDU) (HR 5.65, 95% CI 2.41 to 13.23).
HIV testing is a crucial first step in the HIV care continuum and an important HIV prevention tool. This study confirmed the need to reach high-risk populations (MSM, sex with HIV-positive individuals, individuals with IDU) and to increase comprehensive prevention services so that high-risk individuals stay HIV uninfected. HIV testing in mobile vans may be an effective outreach strategy for identifying infection in certain populations at high risk for HIV.
美国许多感染艾滋病毒的人并不知道自己的诊断结果，因此无法接受治疗服务，其临床结果更差，且更有可能将艾滋病毒传播给他人。移动车检测可能会增加艾滋病毒检测和诊断。我们的目标是描述使用移动车检测的个体中艾滋病毒血清转换的危险因素。
在马里兰州巴尔的摩市 2004 年 9 月至 2009 年 8 月期间进行的一项 HIV 监测数据集中，对至少进行了两次 HIV 检测的移动车检测使用者进行了病例队列研究（n=543）。随机选择了一个子队列（n=423）；所有其他病例均从母队列中添加。在随访时，有 122 例（总共 122 例，子队列中 2 例）记录到血清转换。分析的一个独特方面是使用惩教署的数据记录初次和随后检测之间的监禁情况。使用多变量 Cox 比例风险模型比较血清转换个体与未发生血清转换个体的 HIV 传播危险因素。
在 8756 名个体中，有 122 例发生 HIV 血清转换（1.4%），这一比率高于巴尔的摩市卫生局性传播疾病诊所患者的 1%。HIV 血清转换风险增加与男男性行为者（MSM）（HR 32.76，95%CI 5.62 至 191.12）、与 HIV 阳性伴侣发生性行为（HR 70.2，95%CI 9.58 至 514.89）和静脉吸毒（IDU）（HR 5.65，95%CI 2.41 至 13.23）有关。
艾滋病毒检测是艾滋病毒护理连续体的重要第一步，也是艾滋病毒预防的重要工具。本研究证实，需要接触高危人群（MSM、与 HIV 阳性个体发生性行为、IDU 个体）并增加全面预防服务，以使高危个体保持 HIV 阴性。在移动车中进行艾滋病毒检测可能是识别某些高危人群感染艾滋病毒的有效外展策略。
