乌干达西南部纳基瓦莱难民营中难民接受家庭 HIV 检测的可行性和可接受性：一项试点研究。
Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda.
机构信息
Department of Emergency Medicine, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA, 02114-2698, USA.
出版信息
BMC Infect Dis. 2018 Jul 16;18(1):332. doi: 10.1186/s12879-018-3238-y.
BACKGROUND
Refugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale.
METHODS
From February-March 2014, we visited homes in 3 villages in Nakivale up to 3 times and offered HIV testing. We enrolled adults who spoke English, Kiswahili, Kinyarwanda, or Runyankore; some were refugees and some Ugandan nationals. We surveyed them about their socio-demographic characteristics. We evaluated the proportion of individuals encountered (feasibility) and assessed participation in HIV testing among those encountered (acceptability). We compared characteristics of home-based and clinic-based testers (from a prior study in Nakivale) using Wilcoxon rank sum and Pearson's chi-square tests. We examined the relationship between a limited number of factors (time of visit, sex, and number of individuals at home) on willingness to test, using logistic regression models with the generalized estimating equations approach to account for clustering.
RESULTS
Of 566 adults living in 319 homes, we encountered 507 (feasibility = 90%): 353 (62%) were present at visit one, 127 (22%) additional people at visit two, and 27 (5%) additional people at visit three. Home-based HIV testing participants totaled 378 (acceptability = 75%). Compared to clinic-based testers, home-based testers were older (median age 30 [IQR 24-40] vs 28 [IQR 22-37], p < 0.001), more likely refugee than Ugandan national (93% vs 79%, < 0.001), and more likely to live ≥1 h from clinic (74% vs 52%, < 0.001). The HIV prevalence was lower, but not significantly, in home-based compared to clinic-based testing participants (1.9 vs 3.4% respectively, p = 0.27). Testing was not associated with time of visit (p = 0.50) or sex (p = 0.66), but for each additional person at home, the odds of accepting HIV testing increased by over 50% (OR 1.52, 95%CI 1.12-2.06, p = 0.007).
CONCLUSIONS
Home-based HIV testing in Nakivale Refugee Settlement was feasible, with 90% of eligible individuals encountered within 3 visits, and acceptable with 75% willing to test for HIV, with a yield of nearly 2% individuals tested identified as HIV-positive.
背景
撒哈拉以南非洲的难民既面临艾滋病毒感染的风险，也面临艾滋病毒检测的障碍。我们开展了一项试点研究，以确定在乌干达纳基瓦莱难民营进行家庭为基础的艾滋病毒检测的可行性和可接受性，并比较纳基瓦莱的家庭为基础和诊所为基础的检测参与者。
方法
从 2014 年 2 月至 3 月，我们三次访问纳基瓦莱的 3 个村庄的家庭，并提供艾滋病毒检测。我们招募了会说英语、斯瓦希里语、基尼亚卢旺达语或鲁恩扬科雷语的成年人；其中一些是难民，一些是乌干达国民。我们对他们的社会人口特征进行了调查。我们评估了遇到的个人比例（可行性），并评估了遇到的个人参与艾滋病毒检测的情况（可接受性）。我们使用 Wilcoxon 秩和检验和 Pearson 卡方检验比较了家庭和诊所测试者的特征（来自纳基瓦莱的先前研究）。我们使用逻辑回归模型和广义估计方程方法，根据就诊时间、性别和家中人数等少数因素，考察了对检测意愿的关系，以解释聚类。
结果
在 319 户家庭中，有 566 名成年人居住，我们遇到了 507 名（可行性=90%）：353 名（62%）在第一次访问时在场，127 名（22%）在第二次访问时在场，27 名（5%）在第三次访问时在场。家庭为基础的艾滋病毒检测参与者共有 378 人（可接受性=75%）。与诊所测试者相比，家庭测试者年龄较大（中位数 30 [IQR 24-40] 比 28 [IQR 22-37]，p<0.001），更可能是难民而不是乌干达国民（93%比 79%，<0.001），并且更可能居住在离诊所≥1 小时的地方（74%比 52%，<0.001）。家庭为基础的检测参与者的艾滋病毒感染率较低，但差异无统计学意义（分别为 1.9%和 3.4%，p=0.27）。检测与就诊时间（p=0.50）或性别（p=0.66）无关，但家中每增加 1 人，接受艾滋病毒检测的几率增加超过 50%（OR 1.52，95%CI 1.12-2.06，p=0.007）。
结论
在纳基瓦莱难民营进行家庭为基础的艾滋病毒检测是可行的，在 3 次访问中有 90%的合格人员被发现，可接受性为 75%，愿意接受艾滋病毒检测，近 2%接受检测的人被发现艾滋病毒呈阳性。
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