Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Biomedical Research and Training Institute, Zimbabwe.
Curr Opin HIV AIDS. 2018 May;13(3):257-264. doi: 10.1097/COH.0000000000000452.
HIV/AIDS is one of the leading causes of death among adolescents in sub-Saharan Africa and 40% of new HIV infections worldwide occur in this group. HIV testing and counselling (HTC) is the critical first step to accessing HIV treatment. The prevalence of undiagnosed HIV infection is substantially higher in adolescents compared with adults. We review barriers to HTC for adolescents and emerging HTC strategies appropriate to adolescents in sub-Saharan Africa.
There are substantial individual, health system and legal barriers to HTC among adolescents, and stigma by providers and communities remains an important obstacle. There has been progress made in recent years in developing strategies that address some of these barriers, increase uptake of HTC and yield of HIV. These include targeted approaches focused on provision of HTC among those higher risk of being infected, for example, index-linked HTC and use of screening tools to identify those at risk of HIV. Community-based HIV-testing approaches including HIV self-testing and incentives have also been shown to increase uptake of HTC.
In implementing HTC strategies, consideration must be given to scalability and cost-effectiveness. HTC approaches must be coupled with linkage to appropriate care and prevention services.
在撒哈拉以南非洲，艾滋病毒/艾滋病是青少年死亡的主要原因之一，全球 40%的新艾滋病毒感染发生在这一年龄组。艾滋病毒检测和咨询（HTC）是获得艾滋病毒治疗的关键第一步。与成年人相比，青少年中未确诊的艾滋病毒感染率要高得多。我们回顾了青少年接受 HTC 的障碍以及撒哈拉以南非洲青少年新出现的 HTC 策略。
青少年接受 HTC 存在着实质性的个人、卫生系统和法律障碍，提供者和社区的污名化仍然是一个重要的障碍。近年来，在制定战略方面取得了一些进展，这些战略旨在解决其中一些障碍，增加 HTC 的接受率和艾滋病毒的检出率。这些策略包括针对那些感染风险较高的人群提供 HTC 的针对性方法，例如，与索引相关的 HTC 和使用筛查工具来识别艾滋病毒感染风险人群。基于社区的艾滋病毒检测方法，包括艾滋病毒自检和激励措施，也已被证明可以提高 HTC 的接受率。
在实施 HTC 策略时，必须考虑可扩展性和成本效益。HTC 方法必须与适当的护理和预防服务相联系。
