National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya.
Department of Global Health, University of Washington, Seattle, WA, USA.
J Int AIDS Soc. 2019 Jul;22 Suppl 3(Suppl Suppl 3):e25305. doi: 10.1002/jia2.25305.
INTRODUCTION: We have previously demonstrated that assisted partner services (aPS) increases HIV testing and case finding among partners of persons living with HIV (PLHIV) in a cluster randomized trial in Kenya. However, the efficacy of aPS may vary across populations. In this analysis, we explore differences in aPS efficacy by characteristics of index participants. METHODS: Eighteen HIV testing sites were randomized to immediate versus 6-week delayed aPS. Participants were PLHIV (or index participants) and their sexual partners. Partners of index participants were contacted for HIV testing and linked to care if HIV positive. Primary outcomes were the number of partners per index participant who: 1) tested for HIV, 2) tested HIV positive and 3) enrolled in HIV care. We used generalized estimating equations to assess differences in aPS efficacy by region, testing location, gender, age and knowledge of HIV status. RESULTS: From 2013 to 2015, the study enrolled 1119 index participants, 625 of whom were in the immediate group. These index participants named 1286 sexual partners. Immediate aPS was more efficacious than delayed aPS in promoting HIV testing among partners in high compared to low HIV prevalence regions (Nyanza incidence rate ratio (IRR) 7.2; 95% confidence interval (CI) 5.4, 9.6 vs. Nairobi/Central IRR 3.4 95% CI 2.3, 4.8). Higher rates of partner HIV testing were also observed for index participants in rural/peri-urban compared to urban sites (IRR 6.6; 95% CI 4.5, 9.6 vs. IRR 3.5 95% CI 2.5, 5.0 respectively), for female versus male index participants (IRR 5.8 95% CI 4.2, 7.9 vs. IRR 3.7; 95% CI 2.4, 5.8 respectively) and for newly diagnosed versus known HIV-positive index participants (IRR 6.0 95% CI 4.2, 8.7 vs. IRR 3.3; 95% CI 2.0, 7.7 respectively). Providing aPS to female versus male index participants also had a significantly higher HIV case finding rate (IRR 9.1; 95% CI 4.0, 20.9 vs. IRR 3.2 95% CI 1.7, 6.0 respectively.) CONCLUSIONS: While it is known that aPS promotes increases in HIV testing and case finding, this is the first study to demonstrate significant differences in aPS efficacy across characteristics of the index participant. Understanding these differences and their drivers will be critical as aPS is brought to scale in order to ensure all PLHIV have access to these services.
介绍：我们之前已经证明，在肯尼亚的一项集群随机试验中，辅助伴侣服务（aPS）可以增加艾滋病毒感染者（PLHIV）伴侣的艾滋病毒检测和病例发现。然而，aPS 的疗效可能因人群而异。在本分析中，我们通过指标参与者的特征来探讨 aPS 疗效的差异。
方法：18 个艾滋病毒检测点被随机分配到立即进行与 6 周延迟 aPS。参与者为 PLHIV（或指标参与者）及其性伴侣。如果 HIV 阳性，指标参与者的伴侣将被联系进行艾滋病毒检测并纳入护理。主要结局是每个指标参与者的以下数量的伴侣：1）接受 HIV 检测，2）检测 HIV 阳性，3）登记接受艾滋病毒护理。我们使用广义估计方程评估区域、检测地点、性别、年龄和 HIV 状况知晓度对 aPS 疗效的差异。
结果：2013 年至 2015 年，该研究纳入了 1119 名指标参与者，其中 625 名参与者在立即组。这些指标参与者共提名了 1286 名性伴侣。与延迟 aPS 相比，立即 aPS 在高 HIV 流行地区比低 HIV 流行地区更有效地促进了伴侣的 HIV 检测（奈瓦沙发病率比（IRR）7.2；95%置信区间（CI）5.4-9.6 与内罗毕/中央 IRR 3.4；95% CI 2.3-4.8）。在农村/城乡结合部的指标参与者中，伴侣 HIV 检测率也更高（IRR 6.6；95% CI 4.5-9.6 与 IRR 3.5；95% CI 2.5-5.0 分别），与男性指标参与者相比，女性指标参与者的 HIV 检测率也更高（IRR 5.8；95% CI 4.2-7.9 与 IRR 3.7；95% CI 2.4-5.8 分别），与新诊断的 HIV 阳性指标参与者相比，已知 HIV 阳性的指标参与者的 HIV 检测率也更高（IRR 6.0；95% CI 4.2-8.7 与 IRR 3.3；95% CI 2.0-7.7 分别）。与男性指标参与者相比，为女性指标参与者提供 aPS 也具有更高的 HIV 病例检出率（IRR 9.1；95% CI 4.0-20.9 与 IRR 3.2；95% CI 1.7-6.0 分别）。
结论：虽然已知 aPS 可促进 HIV 检测和病例发现的增加，但这是第一项表明 aPS 疗效在指标参与者特征方面存在显著差异的研究。随着 aPS 的推广以确保所有 PLHIV 都能获得这些服务，了解这些差异及其驱动因素将至关重要。
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