Ruzagira Eugene, Grosskurth Heiner, Kamali Anatoli, Baisley Kathy
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
J Int AIDS Soc. 2017 Oct;20(2). doi: 10.1002/jia2.25014.
The aim of this study was to determine whether counselling provided subsequent to HIV testing and referral for care increases linkage to care among HIV-positive persons identified through home-based HIV counselling and testing (HBHCT) in Masaka, Uganda.
The study was an open-label cluster-randomized trial. 28 rural communities were randomly allocated (1:1) to intervention (HBHCT, referral and counselling at one and two months) or control (HBHCT and referral only). HIV-positive care-naïve adults (≥18 years) were enrolled. To conceal participants' HIV status, one HIV-negative person was recruited for every three HIV-positive participants. Primary outcomes were linkage to care (clinic-verified registration for care) status at six months, and time to linkage. Primary analyses were intention-to-treat using random effects logistic regression or Cox regression with shared frailty, as appropriate.
Three hundred and two(intervention, n = 149; control, n = 153) HIV-positive participants were enrolled. Except for travel time to the nearest HIV clinic, baseline participant characteristics were generally balanced between trial arms. Retention was similar across trial arms (92% overall). One hundred and twenty-seven (42.1%) participants linked to care: 76 (51.0%) in the intervention arm versus 51 (33.3%) in the control arm [odds ratio = 2.18, 95% confidence interval (CI) = 1.26-3.78; p = 0.008)]. There was evidence of interaction between trial arm and follow-up time (p = 0.009). The probability of linkage to care, did not differ between arms in the first two months of follow-up, but was subsequently higher in the intervention arm versus the control arm [hazard ratio = 4.87, 95% CI = 1.79-13.27, p = 0.002].
Counselling substantially increases linkage to care among HIV-positive adults identified through HBHCT and may enhance efforts to increase antiretroviral therapy coverage in sub-Saharan Africa.
本研究的目的是确定在乌干达马萨卡通过家庭式艾滋病毒咨询与检测（HBHCT）发现的艾滋病毒呈阳性者中，在艾滋病毒检测及转介接受治疗后提供咨询服务是否能增加其接受治疗的比例。
该研究为开放标签整群随机试验。28个农村社区被随机分配（1:1）至干预组（HBHCT、在第1个月和第2个月进行转介及咨询）或对照组（仅HBHCT和转介）。纳入未接受过艾滋病毒治疗的艾滋病毒呈阳性的成年人（≥18岁）。为隐瞒参与者的艾滋病毒感染状况，每招募3名艾滋病毒呈阳性的参与者就招募1名艾滋病毒呈阴性的人。主要结局为6个月时接受治疗的比例（经诊所核实的接受治疗登记情况）以及接受治疗的时间。主要分析采用意向性分析，酌情使用随机效应逻辑回归或带有共享脆弱性的Cox回归。
共纳入302名艾滋病毒呈阳性的参与者（干预组n = 149；对照组n = 153）。除了到最近的艾滋病毒诊所的出行时间外，各试验组参与者的基线特征总体平衡。各试验组的保留率相似（总体为92%）。127名（42.1%）参与者接受了治疗：干预组76名（51.0%），对照组51名（33.3%）[优势比 = 2.18，95%置信区间（CI）= 1.26 - 3.78；p = 0.008]。有证据表明试验组与随访时间之间存在交互作用（p = 0.009）。在随访的前两个月，各试验组接受治疗的概率无差异，但随后干预组高于对照组[风险比 = 4.87，95%CI = 1.79 - 13.27，p = 0.002]。
咨询服务显著提高了通过HBHCT发现的艾滋病毒呈阳性成年人接受治疗的比例，并可能有助于加强撒哈拉以南非洲地区扩大抗逆转录病毒治疗覆盖范围的工作。
Zotero 插件