Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA.
Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, South Africa.
J Acquir Immune Defic Syndr. 2019 Aug 1;81(4):365-370. doi: 10.1097/QAI.0000000000002048.
There is an imperative need for innovative interventions to identify people living with HIV and initiate them on antiretroviral therapy. The objective of this study was to determine the feasibility of providing index partner/child testing of people living with HIV.
We trained 86 nurses and counsellors in 56 public health facilities in 6 high HIV burden Districts in South Africa 2017 to provide index partner/child testing (tracing and testing of partners/children of people living with HIV). We collected programmatic data including index partner/child HIV positivity by age, gender, and location of testing. In subanalyses, we evaluated factors associated with identifying HIV-positive partners and children in separate models using multivariable logistic regression.
We tested 16,033 partners and children of index patients between October 2017 and June 2018. Most of those tested were women (61%) and 20-39 years old (39%). Overall, 6.4% were 10-14 years old, 9.5% were 15-19 years, and 8% were ≥50 years. HIV positivity was 38% [95% confidence interval (CI) = 36% to 40%]. In children ages 10-14 years, 13% were HIV-infected (95% CI = 11% to 14%). In subanalyses, HIV positivity in partners was associated with their increased age [adjusted odds ratio (aOR) for increase in 5-year age category = 1.21; 95% CI = 1.04 to 1.42], female gender (aOR = 1.38; 95% CI = 1.04 to 1.82), and index partner bringing the partner in for HIV testing vs. referring the partner through the provider or recommending testing to the partner (aOR = 1.94, 95% CI = 1.43 to 2.63), adjusting for location of testing. Almost all patients diagnosed (97%) were referred to antiretroviral therapy.
Providing index partner/child testing was feasible and we identified a very high yield when testing partners and children of index patients. Index partner and children testing should be offered to all patients living with HIV to improve case finding.
我们迫切需要创新干预措施来发现 HIV 感染者并为他们提供抗逆转录病毒治疗。本研究旨在确定为 HIV 感染者的性伴/子女提供检测的可行性。
我们于 2017 年在南非 6 个高 HIV 负担地区的 56 家公共卫生机构培训了 86 名护士和咨询员，以提供性伴/子女检测（对 HIV 感染者的性伴/子女进行追踪和检测）。我们收集了方案数据，包括按年龄、性别和检测地点划分的性伴/子女 HIV 阳性率。在亚分析中，我们使用多变量逻辑回归模型分别评估了与识别 HIV 阳性性伴和子女相关的因素。
我们于 2017 年 10 月至 2018 年 6 月期间对 16033 名 HIV 感染者的性伴和子女进行了检测。大多数检测对象是女性（61%），年龄在 20-39 岁（39%）。总的来说，6.4%的人年龄在 10-14 岁，9.5%的人年龄在 15-19 岁，8%的人年龄在 50 岁以上。HIV 阳性率为 38%[95%置信区间（CI）为 36%至 40%]。在 10-14 岁的儿童中，13%感染了 HIV（95%CI=11%至 14%）。在亚分析中，性伴 HIV 阳性与年龄增加相关[5 岁年龄组每增加一年，调整后的优势比（aOR）为 1.21；95%CI=1.04 至 1.42]、女性性别（aOR=1.38；95%CI=1.04 至 1.82）、以及性伴由感染者带来进行 HIV 检测而不是通过提供者转介或建议性伴进行检测（aOR=1.94，95%CI=1.43 至 2.63），这些因素在调整检测地点后依然成立。几乎所有诊断出的患者（97%）都被转介到抗逆转录病毒治疗机构。
为 HIV 感染者的性伴/子女提供检测是可行的，而且我们从检测 HIV 感染者的性伴和子女中发现了非常高的阳性率。应向所有 HIV 感染者提供性伴/子女检测，以提高病例发现率。
