London School of Hygiene and Tropical Medicine, London, UK.
Zambia AIDS Related TB Project, Lusaka, Zambia.
Trop Med Int Health. 2018 Jun;23(6):678-690. doi: 10.1111/tmi.13055. Epub 2018 Apr 16.
The HPTN 071 (PopART) trial is examining the impact of a package including universal testing and treatment on community-level HIV incidence in Zambia and South Africa. We conducted a nested case-control study to examine factors associated with acceptance of home-based HIV testing and counselling (HB-HTC) delivered by community HIV-care providers (CHiPs) in PopART intervention communities.
Of 295 447 individuals who were offered testing, random samples of individuals who declined HB-HTC (cases) and accepted HB-HTC (controls), stratified by gender and community, were selected. Odds ratios comparing cases and controls were estimated using multivariable logistic regression.
Data from 642 participants (313 cases, 329 controls) were analysed. There were no differences between cases and controls by demographic or behavioural characteristics including age, marital or socio-economic position. Participants who felt they could be open with CHiPs (AOR: 0.46, 95% CI: 0.30-0.71, P < 0.001); self-reported as not previously tested (AOR: 0.64; 95% CI: 0.43-0.95, P = 0.03); considered HTC at home to be convenient (AOR: 0.38, 95% CI: 0.27-0.54, P = 0.001); knowing others who had accepted HB-HTC from the CHiPs (AOR: 0.49, 95% CI: 0.31-0.77, P = 0.002); or were motivated to get treatment without delay (AOR: 0.60, 95% CI: 0.43-0.85, P = 0.004) were less likely to decline the offer of HB-HCT. Those who self-reported high-risk sexual behaviour were also less likely to decline HB-HCT (AOR: 0.61, 95% CI: 0.39-0.93, P = 0.02). Having stigmatising attitudes about HB-HTC was not an important barrier to HB-HCT uptake. Men who reported fear of HIV were more likely to decline HB-HCT (AOR: 2.68, 95% CI: 1.33-5.38, P = 0.005).
Acceptance of HB-HTC was associated with lack of previous HIV testing, positive attitudes about HIV services/treatment and perception of high sexual risk. Uptake of HB-HCT among those offered it was similar across a range of demographic and behavioural subgroups suggesting it was 'universally' acceptable.
HPTN 071（PopART）试验正在研究在赞比亚和南非，包括普遍检测和治疗在内的一揽子计划对社区层面艾滋病毒发病率的影响。我们进行了一项嵌套病例对照研究，以研究接受社区艾滋病毒护理提供者（CHiPs）提供的基于家庭的艾滋病毒检测和咨询（HB-HTC）的因素，这些提供者是 PopART 干预社区的一部分。
在 295447 名接受检测的人中，随机抽取了拒绝 HB-HTC 的个体（病例）和接受 HB-HTC 的个体（对照）的样本，按性别和社区分层。使用多变量逻辑回归估计病例和对照之间的优势比。
对 642 名参与者（313 例病例，329 例对照）的数据进行了分析。病例和对照在年龄、婚姻或社会经济地位等人口统计学或行为特征方面没有差异。认为自己可以与 CHiPs 坦诚相待的参与者（优势比：0.46，95%置信区间：0.30-0.71，P<0.001）；自我报告从未接受过检测（优势比：0.64；95%置信区间：0.43-0.95，P=0.03）；认为在家接受 HTC 很方便（优势比：0.38，95%置信区间：0.27-0.54，P=0.001）；知道其他人曾接受过 CHiPs 的 HB-HTC（优势比：0.49，95%置信区间：0.31-0.77，P=0.002）；或有立即接受治疗的动力（优势比：0.60，95%置信区间：0.43-0.85，P=0.004）的参与者不太可能拒绝 HB-HCT 服务。那些自我报告有高危性行为的人也不太可能拒绝 HB-HCT（优势比：0.61，95%置信区间：0.39-0.93，P=0.02）。对 HB-HTC 的污名化态度并不是阻碍其接受的重要因素。报告对 HIV 感到恐惧的男性更有可能拒绝 HB-HCT（优势比：2.68，95%置信区间：1.33-5.38，P=0.005）。
接受 HB-HTC 与缺乏先前的 HIV 检测、对 HIV 服务/治疗的积极态度以及对高性风险的感知有关。在提供给他们的 HB-HCT 中，接受率在一系列人口统计学和行为亚组中相似，这表明它是“普遍”可接受的。
