Knight Vickie, Guy Rebecca, McNulty Anna, Wand Handan
Sydney Sexual Health Centre, South East Sydney Local Health District, 8 Macquarie Street, Sydney, NSW 2000, Australia; and The Kirby Institute, UNSW Sydney, High Street, Kensington, NSW 2052, Australia; and Corresponding author. Email:
The Kirby Institute, UNSW Sydney, High Street, Kensington, NSW 2052, Australia.
Sex Health. 2019 Apr;16(2):124-132. doi: 10.1071/SH18083.
Background HIV infection in gay and bisexually active men (GBM) is an international public health concern and increasing HIV testing frequency is an important prevention goal. In this study we assessed the effect of introducing the Xpress clinic on repeat HIV testing in high-risk GBM in Sydney, Australia.
The study population consisted of higher-risk (>5 male partners in the preceding 3 months) HIV-negative GBM attending the Sydney Sexual Health Centre for HIV screening between 1 October 2009 and 31 December 2013 (12 months before Xpress was introduced and 3 years after). Poisson regression models were used to calculate the average annual trend of retesting within 6 months by quarter, and a retrospective cohort was constructed in which multivariate regression methods were used to assess the association between attendance at the Xpress clinic and repeat HIV testing in 6 months.
Among high-risk GBM, HIV retesting increased from 32% in Quarter 1 of 2011 to 48% in Quarter 4 of 2013 (Ptrend<0.001). There was no significant trend in the proportion of high-risk GBM retesting within 6 months by quarter in the period before Xpress (1 October 2009-30 September 2010; Ptrend=0.69), but there was a significant upward trend after Xpress implementation (1 January 2011-31 December 2013; Ptrend<0.001). The summary rate ratio in the before versus during Xpress period in all GBM was 1.27 (95% confidence interval (CI) 1.15-1.40; P<0.001). In the multivariate analysis, attending the Xpress clinic was independently associated with retesting within 6 months of an initial test (adjusted OR 2.78; 95% CI 2.12-3.66; P<0.001) after adjusting for other demographics and risk factors.
This study consistently shows that optimising current services by introducing express clinics was able to increase HIV testing frequency in high-risk GBM and should be adopted more widely.
背景 男同性恋者和双性恋活跃男性（GBM）中的HIV感染是一个国际公共卫生问题，提高HIV检测频率是一项重要的预防目标。在本研究中，我们评估了在澳大利亚悉尼引入Xpress诊所对高危GBM重复进行HIV检测的影响。
研究人群包括2009年10月1日至2013年12月31日期间（引入Xpress诊所前12个月和引入后3年）前往悉尼性健康中心进行HIV筛查的高危（前3个月内有超过5名男性性伴侣）HIV阴性GBM。采用泊松回归模型按季度计算6个月内再次检测的年均趋势，并构建回顾性队列，其中使用多变量回归方法评估就诊于Xpress诊所与6个月内重复进行HIV检测之间的关联。
在高危GBM中，HIV再次检测率从2011年第一季度的32%增至2013年第四季度的48%（Ptrend<0.001）。在引入Xpress诊所之前的时期（2009年10月1日至2010年9月30日），按季度计算的高危GBM在6个月内再次检测的比例没有显著趋势（Ptrend=0.69），但在引入Xpress诊所后有显著上升趋势（2011年1月1日至2013年12月31日；Ptrend<0.001）。在所有GBM中，引入Xpress诊所之前与期间的汇总率比为1.27（95%置信区间（CI）1.15 - 1.40；P<0.001）。在多变量分析中，在调整了其他人口统计学和风险因素后，就诊于Xpress诊所与初次检测后6个月内再次检测独立相关（调整后的OR为2.78；95%CI 2.12 - 3.66；P<0.001）。
本研究一致表明，通过引入快速诊所优化现有服务能够提高高危GBM的HIV检测频率，应更广泛地采用。
