Institute for Global Health, University College London, London, United Kingdom.
HIV and STIs Department, Public Health England, London, United Kingdom.
JAMA Netw Open. 2019 Mar 1;2(3):e190864. doi: 10.1001/jamanetworkopen.2019.0864.
Black African adults are disproportionately affected by HIV in the United Kingdom. Many within this population acquire HIV after migration or are diagnosed late. Data are needed to inform targeted interventions to increase HIV testing and prevention in this population.
To inform future HIV prevention strategies by estimating diagnosed and undiagnosed HIV infection and measuring changes in HIV testing rates in black African adults in London, United Kingdom.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a self-completed survey conducted from September 20 to December 3, 2016. Questionnaires were linked to an optional, anonymous oral fluid HIV test and compared with data from a previous survey (2004). Respondents were recruited from social and commercial venues frequented by black African adults in London. Of 2531 individuals approached in 63 venues, 752 agreed to participate. Data were analyzed initially in March 2017 (as part of internal reporting) and again in August 2018.
Self-reported HIV testing within the past 5 years; diagnosed and undiagnosed HIV prevalence. Logistic regression examined factors associated with HIV testing by sex.
In total, 292 women (median [interquartile range] age, 31 [25.0-41.5] years) and 312 men (median [interquartile range] age, 35 [25.0-41.5] years) were included in the analysis. More than half of men (159 [51.0%]) and women (154 [52.7%]) had been tested for HIV in the past 5 years. In multivariable analysis, HIV testing was associated with a range of factors in both sexes, including health service attendance, time in the United Kingdom, and sexually transmitted infection diagnosis. Increases in HIV testing in the past 5 years were observed between 2004 and 2016 for both sexes. In the 2016 sample, 219 of 235 women (93.2%) and 206 of 228 men (90.4%) tested HIV negative. Among those testing positive, 56.3% of women (9 of 16) and 40.9% of men (9 of 22) self-reported as HIV negative or untested, indicating they were living with undiagnosed HIV. A fifth of women (20.7%) and 25.0% of men reported condomless last sex with a partner of different or unknown HIV status in the past year.
Despite efforts to increase HIV testing, uptake in black African communities in London remains modest. This study identified a large fraction of undiagnosed infection-greater than other at-risk populations-suggesting that the prevention and care needs of this group are not adequately met.
在英国，黑非洲成年人不成比例地受到艾滋病毒的影响。该人群中的许多人在移民后感染了艾滋病毒，或者被诊断为晚期。需要数据来为这一人群提供有针对性的干预措施，以增加艾滋病毒检测和预防。
通过估计黑非洲成年人在伦敦的确诊和未确诊的艾滋病毒感染情况，并衡量艾滋病毒检测率的变化，为未来的艾滋病毒预防策略提供信息。
设计、地点和参与者：这是一项横断面研究，使用了 2016 年 9 月 20 日至 12 月 3 日期间进行的自我完成的调查。问卷调查与可选的匿名口腔液艾滋病毒检测相关联，并与之前的一项调查（2004 年）的数据进行了比较。受访者是从伦敦黑非洲成年人常去的社交和商业场所招募的。在 63 个场所中，有 2531 人应邀参加，其中 752 人同意参加。数据最初于 2017 年 3 月（作为内部报告的一部分）和 2018 年 8 月再次进行了分析。
在过去 5 年内自我报告的艾滋病毒检测；确诊和未确诊的艾滋病毒流行率。逻辑回归分析了按性别划分的与艾滋病毒检测相关的因素。
共有 292 名女性（中位数[四分位距]年龄，31 [25.0-41.5] 岁）和 312 名男性（中位数[四分位距]年龄，35 [25.0-41.5] 岁）被纳入分析。超过一半的男性（159 [51.0%]）和女性（154 [52.7%]）在过去 5 年内接受过艾滋病毒检测。在多变量分析中，在两性中，艾滋病毒检测与一系列因素相关，包括医疗服务的利用、在英国的时间以及性传播感染的诊断。在过去 5 年中，两性的艾滋病毒检测均有所增加。在 2016 年的样本中，235 名女性中有 219 名（93.2%）和 228 名男性中有 206 名（90.4%）检测结果为 HIV 阴性。在检测呈阳性的人群中，9 名女性（56.3%）和 9 名男性（40.9%）自述 HIV 阴性或未检测，表明他们患有未确诊的 HIV，这表明他们患有未确诊的 HIV。五分之一的女性（20.7%）和 25.0%的男性报告在过去一年中与不同或未知 HIV 状况的伴侣发生过无保护的最后一次性行为。
尽管努力增加艾滋病毒检测，但伦敦黑非洲社区的检测率仍然较低。这项研究发现了大量未确诊的感染病例-超过其他高危人群-表明这一群体的预防和护理需求没有得到充分满足。
