Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
The Tazama Project, National Institute for Medical Research, Mwanza, Tanzania.
Trop Med Int Health. 2018 Dec;23(12):1384-1393. doi: 10.1111/tmi.13153. Epub 2018 Oct 24.
To measure linkage to care and antiretroviral therapy (ART) initiation among newly diagnosed individuals with HIV in a rural Tanzanian community.
We included all new HIV diagnoses of adults made between 2014 and 2017 during community- or facility-based HIV testing and counselling (HTC) in a rural ward in northwest Tanzania. Community-based HTC included population-level HIV serological testing (sero-survey), and facility-based HTC included a stationary, voluntary HTC clinic (VCT) and an antenatal clinic (ANC) offering provider-initiated HTC (ANC-PITC). Cox regression models were used to compare linkage to care rates by testing modality and identify associated factors. Among those in care, we compared initial CD4 cell counts and ART initiation rates by testing modality.
A total of 411 adults were newly diagnosed, of whom 10% (27/265 sero-survey), 18% (3/14 facility-based ANC-PITC) and 53% (68/129 facility-based VCT) linked to care within 90 days. Individuals diagnosed using facility-based VCT were seven times (95% CI: 4.5-11.0) more likely to link to care than those diagnosed in the sero-survey. We found no difference in linkage rates between those diagnosed using facility-based ANC-PITC and sero-survey (P = 0.26). Among individuals in care, 63% of those in the sero-survey had an initial CD4 count >350 cells/mm vs. 29% of those using facility-based VCT (P = 0.02). The proportion who initiated ART within 1 year of linkage to care was similar for both groups (94% sero-survey vs. 85% facility-based VCT; P = 0.16).
Community-based sero-surveys are important for earlier diagnosis of HIV-positive individuals; however, interventions are essential to facilitate linkage to care.
在坦桑尼亚一个农村社区中，测量新诊断出的艾滋病毒感染者与护理和抗逆转录病毒治疗（ART）的关联情况。
我们纳入了 2014 年至 2017 年间在坦桑尼亚西北部一个农村病房进行的社区或机构为基础的艾滋病毒检测和咨询（HTC）中，新诊断出的成年人的所有 HIV 病例。社区为基础的 HTC 包括人群层面的艾滋病毒血清学检测（血清调查），而机构为基础的 HTC 包括一个固定的、自愿的 HTC 诊所（VCT）和一个提供医护人员启动的 HTC（ANC-PITC）的产前诊所（ANC）。使用 Cox 回归模型比较了不同检测方式的关联率，并确定了相关因素。在已接受治疗的人群中，我们比较了不同检测方式的初始 CD4 细胞计数和 ART 起始率。
共有 411 名成年人新诊断出 HIV，其中 10%（27/265 名血清调查）、18%（3/14 名机构 ANC-PITC）和 53%（68/129 名机构 VCT）在 90 天内与护理机构建立了联系。与血清调查相比，使用机构 VCT 诊断的个体与护理机构建立联系的可能性高出七倍（95%CI：4.5-11.0）。我们发现，使用机构 ANC-PITC 和血清调查诊断的个体之间的关联率没有差异（P=0.26）。在接受治疗的人群中，血清调查中 63%的个体初始 CD4 计数＞350 个细胞/mm，而使用机构 VCT 的个体为 29%（P=0.02）。两组在开始 ART 的比例相似，一年内建立联系的比例分别为 94%（血清调查）和 85%（机构 VCT）（P=0.16）。
社区为基础的血清调查对于早期诊断 HIV 阳性个体非常重要；然而，为了促进与护理机构的联系，干预措施是必不可少的。
