通过对医疗保健提供者进行行为技能培训来增强艾滋病毒指标病例检测被动转诊模式：在马拉维曼戈切区进行的预/后评估。

Enhancing an HIV index case testing passive referral model through a behavioural skills-building training for healthcare providers: a pre-/post-assessment in Mangochi District, Malawi.

机构信息

Baylor College of Medicine Children's Foundation, Lilongwe, Malawi.

Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.

出版信息

J Int AIDS Soc. 2019 Jul;22 Suppl 3(Suppl Suppl 3):e25292. doi: 10.1002/jia2.25292.

DOI:10.1002/jia2.25292

PMID:31321917

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6639699/

Abstract

INTRODUCTION

Although knowledge of HIV positivity is a necessary step towards engagement in HIV care, more than one quarter of HIV-positive Malawians remain unaware of their HIV status. Testing the sexual partners, guardians and children of HIV-positive persons (index case finding or ICF) is a promising way of identifying HIV-positive persons unaware of their HIV status. ICF can be passive where the HIV-positive individual (index) invites a partner (or contact) for HIV testing or active where a health provider assists the index with partner notification and offers HIV testing to the partner. Strategies to improve passive ICF have not been thoroughly studied. We describe the impact of a behavioural skills-building training to enhance healthcare workers' (HCWs) implementation of Malawi's passive ICF programme.

METHODS

In June 2017, HCWs from 36 health facilities in Mangochi were oriented to Malawi's ICF programme and began implementation. In February and April 2018, a total of 573 HCWs from these facilities received further training from the Tingathe Programme. The training focused on eliciting more untested sexual contacts from indexes and better equipping indexes on issuing "family referral slips" to contacts. Monthly programmatic data were abstracted from clinical registers from October 2017 to July 2018. Monthly programmatic indicators were collected from the Index Case Testing Register and the HIV Counselling and Testing Register and were entered into a data set with one record per facility per month. T-tests were used to compare the means of these indicators.

RESULTS

During the ten-month study period, there were 200 facility-months observed before and 124 facility-months observed after training. The mean number of indexes identified per facility-month remained stable after training (pre = 18.9, post = 21.2, p = 0.74), but the mean number of sexual partners listed per facility-month (pre = 6.3, post = 10.6, p < 0.001) increased. The mean number of contacts who received HIV testing (pre = 11.1, post = 24.8, p < 0.001) and the mean number of HIV-positive contacts identified per facility-month (pre = 1.3, post = 2.3, p < 0.001) also increased.

CONCLUSIONS

A brief behavioural skills-building training impacted a range of meaningful outcomes, including identification of HIV-positive individuals in a passive ICF programme. Such approaches could facilitate the identification of HIV-positive persons unaware of their HIV status, a necessary step for engagement in HIV care.

摘要

简介

尽管了解 HIV 阳性情况是参与 HIV 护理的必要步骤，但仍有超过四分之一的 HIV 阳性马拉维人不知道自己的 HIV 状况。对 HIV 阳性者的性伴侣、监护人以及子女进行检测（索引病例发现或 ICF）是发现不知道自己 HIV 状况的 HIV 阳性者的一种有前途的方法。ICF 可以是被动的，即 HIV 阳性者（索引）邀请伴侣（或联系人）进行 HIV 检测，也可以是主动的，即卫生保健提供者协助索引者进行伴侣通知并向伴侣提供 HIV 检测。尚未对改善被动 ICF 的策略进行深入研究。我们描述了一种行为技能培训对增强医疗保健工作者（HCWs）实施马拉维被动 ICF 计划的影响。

方法

2017 年 6 月，来自曼戈乔 36 个卫生设施的 HCWs 接受了马拉维 ICF 计划的培训并开始实施。2018 年 2 月和 4 月，来自这些设施的共 573 名 HCWs 接受了 Tingathe 项目的进一步培训。该培训侧重于从索引者中引出更多未经检测的性接触者，并更好地为索引者提供向接触者发放“家庭转介单”的能力。2017 年 10 月至 2018 年 7 月，从临床登记册中每月提取项目数据。从索引病例检测登记册和艾滋病毒咨询和检测登记册中收集每月项目指标，并将其输入一个数据集中，每个设施每月有一个记录。使用 t 检验比较这些指标的平均值。

结果

在十个月的研究期间，培训前观察到 200 个设施月，培训后观察到 124 个设施月。培训后，每个设施月确定的索引数量保持稳定（培训前=18.9，培训后=21.2，p=0.74），但每个设施月列出的性伴侣数量（培训前=6.3，培训后=10.6，p<0.001）增加。接受 HIV 检测的接触者人数（培训前=11.1，培训后=24.8，p<0.001）和每个设施月发现的 HIV 阳性接触者数量（培训前=1.3，培训后=2.3，p<0.001）也有所增加。