非公民与公民的 HIV 感染状况和治疗覆盖率知识比较：博茨瓦纳组合预防项目（BCPP）。
Comparison of knowledge of HIV status and treatment coverage between non-citizens and citizens: Botswana Combination Prevention Project (BCPP).
机构信息
Centers for Disease Control and Prevention, Gaborone, Botswana.
Public Health, Burnet Institute, Melbourne, Australia.
出版信息
PLoS One. 2019 Aug 29;14(8):e0221629. doi: 10.1371/journal.pone.0221629. eCollection 2019.
INTRODUCTION
Non-citizens often face barriers to HIV care and treatment. Quantifying knowledge of positive HIV status and antiretroviral therapy (ART) coverage among non-citizens in a high HIV-prevalence country like Botswana that is close to achieving UNAIDS "90-90-90" targets may expose important gaps in achieving universal HIV testing and treatment.
METHODS
The Botswana Combination Prevention Project (BCPP) is a pair-matched cluster-randomized trial evaluating the impact of prevention interventions on HIV incidence in 30 rural or peri-urban communities. Community case finding and HIV testing were conducted in home and mobile venues in 15 intervention communities from October 2013-September 2017. In this secondary analysis, we compared HIV positivity, knowledge of positive HIV-status, and ART status among all citizens and non-citizens assessed at intake in the intervention communities.
RESULTS
HIV status was assessed in 57,556 residents in the intervention communities; 4% (n = 2,463) were non-citizens. Five communities accounted for 81% of the total non-citizens assessed. A lower proportion of non-citizens were HIV-positive (15%; n = 369) compared to citizens (21%; n = 11,416) [p = 0.026]; however, a larger proportion of non-citizens did not know their HIV-positive status prior to BCPP testing (75%) as compared to citizens (15%) [p = 0.003]. Among residents with knowledge of their HIV-positive status before BCPP, 79% of the non-citizens (72/91) were on ART compared to 86% (8,267/9,652) of citizens (p = 0.137).
CONCLUSIONS
Although non-citizens were less likely to know their HIV-positive status compared to citizens, there were no differences in treatment uptake among non-citizens and citizens who knew their status. Designing interventions for non-citizens that provide HIV testing and treatment services commensurate to that of citizens as well as targeting communities with the largest number of non-citizens may help close a meaningful gap in the HIV care cascade and ensure ethical treatment for all HIV-positive persons.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT01965470 (Botswana Combination Prevention Project).
简介
非公民在获得艾滋病毒护理和治疗方面往往面临障碍。在博茨瓦纳这样一个艾滋病毒感染率高、接近实现联合国艾滋病规划署“90-90-90”目标的国家，对非公民的艾滋病毒阳性状况和抗逆转录病毒疗法（ART）覆盖率进行量化，可能会暴露出在实现普遍艾滋病毒检测和治疗方面存在的重要差距。
方法
博茨瓦纳组合预防项目（BCPP）是一项配对的集群随机试验，评估预防干预措施对 30 个农村或城市周边社区艾滋病毒发病率的影响。从 2013 年 10 月至 2017 年 9 月，在 15 个干预社区的家庭和流动场所进行社区病例发现和艾滋病毒检测。在这项二次分析中，我们比较了在干预社区接受评估的所有公民和非公民在接受评估时的艾滋病毒阳性率、对艾滋病毒阳性状况的了解以及抗逆转录病毒治疗状况。
结果
在干预社区的 57556 名居民中评估了艾滋病毒状况；4%（n=2463）为非公民。有五个社区占评估的非公民总数的 81%。非公民艾滋病毒阳性的比例较低（15%；n=369），而非公民的比例较高（21%；n=11416）[p=0.026]；然而，与公民（15%）相比，更多的非公民在接受 BCPP 检测之前不知道自己的艾滋病毒阳性状况（75%）[p=0.003]。在知道自己艾滋病毒阳性状况的居民中，非公民中有 79%（72/91）正在接受抗逆转录病毒治疗，而公民中有 86%（8267/9652）[p=0.137]。
结论
尽管与公民相比，非公民不太可能知道自己的艾滋病毒阳性状况，但在知道自己状况的非公民和公民中，治疗率没有差异。为非公民设计提供与公民相称的艾滋病毒检测和治疗服务的干预措施，并针对拥有大量非公民的社区开展工作，可能有助于缩小艾滋病毒护理链中的一个重要差距，并确保所有艾滋病毒阳性者都能得到合乎道德的治疗。
试验注册
ClinicalTrials.gov：NCT01965470（博茨瓦纳组合预防项目）。
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