Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America.
PLoS One. 2019 Aug 1;14(8):e0219996. doi: 10.1371/journal.pone.0219996. eCollection 2019.
The Medical Monitoring Project (MMP) is an HIV surveillance system that provides national estimates of HIV-related behaviors and clinical outcomes. When first implemented, MMP excluded persons living with HIV not receiving HIV care. This analysis will describe new case-surveillance-based methods to identify and recruit persons living with HIV who are out of care and at elevated risk for mortality and ongoing HIV transmission. Stratified random samples of all persons living with HIV were selected from the National HIV Surveillance System in five public health jurisdictions from 2012-2014. Sampled persons were located and contacted through seven different data sources and five methods of contact to collect interviews and medical record abstractions. Data were weighted for non-response and case reporting delay. The modified sampling methodology yielded 1159 interviews (adjusted response rate, 44.5%) and matching medical record abstractions for 1087 (93.8%). Of persons with both interview and medical record data, 264 (24.3%) would not have been included using prior MMP methods. Significant predictors were identified for successful contact (e.g., retention in care, adjusted Odds Ratio [aOR] 5.02; 95% Confidence Interval [CI] 1.98-12.73), interview (e.g. moving out of jurisdiction, aOR 0.24; 95% CI: 0.12-0.46) and case reporting delay (e.g. rural residence, aOR 3.18; 95% CI: 2.09-4.85). Case-surveillance-based sampling resulted in a comparable response rate to existing MMP methods while providing information on an important new population. These methods have since been adopted by the nationally representative MMP surveillance system, offering a model for public health program, research and surveillance endeavors seeking inclusion of all persons living with HIV.
医学监测项目（MMP）是一个 HIV 监测系统，提供有关 HIV 相关行为和临床结果的全国估计数。最初实施时，MMP 排除了未接受 HIV 护理的 HIV 感染者。本分析将描述新的基于病例监测的方法，以识别和招募脱离护理且死亡率和持续 HIV 传播风险较高的 HIV 感染者。从 2012 年至 2014 年，从五个公共卫生管辖区的国家 HIV 监测系统中选择了所有 HIV 感染者的分层随机样本。通过七个不同的数据源和五种联系方式找到并联系了抽样人员，以收集访谈和病历摘录。数据经过非响应和病例报告延迟的加权处理。修改后的抽样方法产生了 1159 次访谈（调整后的响应率为 44.5％）和 1087 次匹配的病历摘录（93.8％）。在具有访谈和病历数据的人中，有 264 人（24.3％）将不会使用先前的 MMP 方法进行纳入。确定了成功联系的重要预测因素（例如，保持在护理中，调整后的优势比[OR]为 5.02；95％置信区间[CI]为 1.98-12.73），访谈（例如，搬出辖区，OR 0.24；95％CI：0.12-0.46）和病例报告延迟（例如，农村居民，OR 3.18；95％CI：2.09-4.85）。基于病例监测的抽样产生了与现有 MMP 方法相当的响应率，同时提供了有关一个重要新人群的信息。此后，这些方法已被全国代表性的 MMP 监测系统采用，为公共卫生计划、研究和监测工作提供了一个模式，这些工作旨在纳入所有 HIV 感染者。
