Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD.
Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria.
J Acquir Immune Defic Syndr. 2018 Sep 1;79(1):e7-e16. doi: 10.1097/QAI.0000000000001756.
BACKGROUND AND SETTING: Because data on the determinants of the HIV care continuum from key populations such as men who have sex with men (MSM) in resource-limited settings are limited, the study aimed to characterize HIV care continuum outcomes and assess individual and network barriers to progression through the HIV care continuum among MSM in Abuja and Lagos, Nigeria. METHODS: TRUST/RV368 study used respondent-driven sampling to accrue MSM into community-based clinics in Nigeria. Participants received HIV testing at enrollment. HIV-infected participants were offered antiretroviral therapy (ART) with HIV RNA testing every 3 months (Abuja) or 6 months (Lagos). Multiple logistic regression models were used to calculate adjusted odds ratios for factors associated with each point in the HIV care continuum, including HIV testing, ART initiation, and 6-month viral suppression. RESULTS: A total of 1506 MSM were recruited, 1178 (78.2%) tested for HIV and 369 (31.3%) were HIV positive newly diagnosed. Of these, 188 (50.1%) initiated ART, 136 (72.3%) completed 6 months, and 96 (70.6%) were virally suppressed. Larger network size and stronger social network support were each positively associated with HIV testing uptake. Factors associated with ART initiation were higher education and stronger social network support. Having stronger social network support was associated with increased odds of viral suppression at 6 months. CONCLUSIONS: Social determinants of health potentiated increased HIV care continuum outcomes. Integration of HIV prevention, HIV counseling and testing services, and universal coverage of ART into a community-based clinic is critical in achieving better HIV care continuum outcomes.
背景与设定:由于资源有限环境下男男性行为者(MSM)等关键人群的 HIV 关怀连续体决定因素的数据有限,本研究旨在描述 HIV 关怀连续体结局,并评估尼日利亚阿布贾和拉各斯 MSM 进入 HIV 关怀连续体各个阶段的个体和网络障碍。
方法:TRUST/RV368 研究采用受访者驱动抽样法在尼日利亚的社区诊所招募 MSM。参与者在入组时接受 HIV 检测。感染 HIV 的参与者被提供抗逆转录病毒治疗(ART),并在阿布贾每 3 个月和拉各斯每 6 个月进行 HIV RNA 检测。采用多变量逻辑回归模型计算与 HIV 关怀连续体各个阶段相关的因素的调整比值比,包括 HIV 检测、ART 启动和 6 个月病毒抑制。
结果:共招募了 1506 名 MSM,其中 1178 名(78.2%)接受了 HIV 检测,369 名(31.3%)新诊断为 HIV 阳性。其中,188 名(50.1%)开始接受 ART,136 名(72.3%)完成了 6 个月疗程,96 名(70.6%)病毒得到抑制。更大的网络规模和更强的社会网络支持与 HIV 检测率的增加呈正相关。与 ART 启动相关的因素是更高的教育程度和更强的社会网络支持。更强的社会网络支持与 6 个月时病毒抑制的可能性增加相关。
结论:健康的社会决定因素促进了 HIV 关怀连续体结局的改善。将 HIV 预防、HIV 咨询和检测服务以及普遍覆盖 ART 整合到社区诊所中,对于实现更好的 HIV 关怀连续体结局至关重要。
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