通过索引检测和伙伴通知服务持续发现大量艾滋病毒病例：津巴布韦三个省份的经验。

INTRODUCTION: Several countries in southern Africa have made significant progress towards reaching the Joint United Nations Programme on HIV/AIDS goal of ensuring that 90% of people living with HIV are aware of their status. In Zimbabwe, progress towards this "first 90" was estimated at 73% in 2016. To reach the remaining people living with HIV who have undiagnosed infection, the Zimbabwe Ministry of Health and Child Care has been promoting index testing and partner notification services (PNS). We describe the implementation of index testing and PNS under the Zimbabwe HIV Care and Treatment (ZHCT) project and the resulting uptake, HIV positivity rate and links to HIV treatment. METHODS: The ZHCT project has been implemented since March 2016, covering a total of 12 districts in three provinces. To assess the project's performance on index testing, we extracted data on HIV testing from the district health information system (DHIS 2) from March 2016 to May 2018, validated it using service registers and calculated monthly HIV positivity rates using Microsoft Excel. Data were disaggregated by district, province, sex and service delivery point. We used SPSS to assess for statistical differences in paired monthly HIV positivity rates by sex, testing site, and province. RESULTS: The average HIV positivity rate rose from 10% during the first six months of implementation to more than 30% by August 2016 and was sustained above 30% through May 2018. The overall facility HIV positivity rate was 4.1% during the same period. The high HIV positivity rate was achieved for both males and females (mean monthly HIV positivity rate of 31.3% for males and 33.7% for females), with females showing significantly higher positivity compared to males (p < 0.001). The ZHCT mean monthly HIV positivity rate from index testing (32.6%) was significantly higher than that achieved through provider-initiated testing and counselling and other facility HIV testing modalities (4.1%, p < 0.001). CONCLUSIONS: The ZHCT project has demonstrated successes in implementing index testing and PNS by attaining a high HIV positivity rate sustained over the study period. As the country moves towards HIV epidemic control, index testing and PNS are critical strategies for targeted HIV case identification.

引言：南部非洲的一些国家在实现联合国艾滋病规划署关于确保 90%艾滋病毒感染者了解自身状况这一“第一个 90”目标方面取得了重大进展。2016 年，津巴布韦在这方面的进展估计达到 73%。为了发现其余未被诊断出感染的艾滋病毒感染者，津巴布韦卫生和儿童保健部一直在推广索引检测和伙伴通知服务（PNS）。我们描述了在津巴布韦艾滋病毒护理和治疗（ZHCT）项目下实施索引检测和 PNS 的情况，以及由此产生的检测人数、艾滋病毒阳性率和与艾滋病毒治疗的关联。

方法：ZHCT 项目自 2016 年 3 月开始实施，覆盖三个省的 12 个地区。为了评估项目在索引检测方面的表现，我们从 2016 年 3 月至 2018 年 5 月从地区卫生信息系统（DHIS 2）中提取艾滋病毒检测数据，使用服务登记册对其进行验证，并使用 Microsoft Excel 计算每月艾滋病毒阳性率。数据按地区、省份、性别和服务提供点进行细分。我们使用 SPSS 评估按性别、检测地点和省份划分的配对每月艾滋病毒阳性率的统计差异。

结果：艾滋病毒阳性率从实施的前六个月的 10%上升到 2016 年 8 月的 30%以上，并在 2018 年 5 月之前一直保持在 30%以上。同期，医疗机构的艾滋病毒阳性率为 4.1%。男性和女性的艾滋病毒阳性率都很高（男性的平均每月艾滋病毒阳性率为 31.3%，女性为 33.7%），女性的阳性率明显高于男性（p<0.001）。ZHCT 通过索引检测获得的平均每月艾滋病毒阳性率（32.6%）明显高于通过提供者启动的检测和咨询以及其他医疗机构艾滋病毒检测方式获得的阳性率（4.1%，p<0.001）。

结论：ZHCT 项目通过实现高艾滋病毒阳性率并持续保持在研究期间，在实施索引检测和 PNS 方面取得了成功。随着该国向艾滋病毒流行控制迈进，索引检测和 PNS 是发现艾滋病毒病例的关键策略。