改善撒哈拉以南非洲城市地区艾滋病毒护理联系的策略:系统评价

Strategies To Improve Linkage To HIV Care In Urban Areas Of Sub-Saharan Africa: A Systematic Review.

作者信息

Koduah Owusu Kwadwo, Adu-Gyamfi Raphael, Ahmed Zamzam

机构信息

School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK.

National AIDS/STI Control Programme, Ghana Health Service, Korle-Bu, Accra, Ghana.

出版信息

HIV AIDS (Auckl). 2019 Dec 2;11:321-332. doi: 10.2147/HIV.S216093. eCollection 2019.

Abstract

Of the 37 million people estimated to be living with HIV globally in 2017, about 24.7 million were in the sub-Saharan Africa region, which has been and remains worst affected by the epidemic. Enrolment of newly diagnosed individuals into care in the region, however, remains poor with up to 54% not being linked to care. Linkage to care is a very important step in the HIV cascade as it is the precursor to initiating antiretroviral therapy (ART), retention in care, and viral suppression. A systematic review was conducted to gather information regarding the strategies that have been documented to increase linkage to care of Persons living with HIV(PLHIV) in urban areas of sub-Saharan Africa. An electronic search was conducted on Scopus, Cochrane central, CINAHL Plus, PubMed and OpenGrey for linkage strategies implemented from 2006. A total of 189 potentially relevant citations were identified, of which 7 were eligible for inclusion. The identified strategies were categorized using themes from literature. The most common strategies included: health system interventions (i.e. comprehensive care, task shifting); patient convenience and accessibility (i.e. immediate CD4 count testing, immediate ART initiation, community HIV testing); behavior interventions and peer support (i.e. assisted partner services, care facilitation, mobile phone appointment reminders, health education) and incentives (i.e. non-cash financial incentives and transport reimbursement). Several strategies showed favorable outcomes: comprehensive care, immediate CD4 count testing, immediate ART initiation, and assisted partner services. Assisted partner services, same day home-based ART initiation, combination intervention strategies and point-of-care CD4 testing significantly improved linkage to care in urban settings of sub-Saharan African region. They can be delivered either in a health facility or in the community but should be facilitated by health workers. There is, however, the need to conduct more linkage-specific studies in the sub-region.

摘要

据估计,2017年全球有3700万人感染艾滋病毒,其中约2470万人在撒哈拉以南非洲地区,该地区一直且仍然是受这一流行病影响最严重的地区。然而,该地区新诊断患者的护理登记情况仍然很差,高达54%的患者未与护理机构建立联系。与护理机构建立联系是艾滋病毒防治流程中非常重要的一步,因为它是启动抗逆转录病毒疗法(ART)、持续接受护理以及病毒抑制的前提。开展了一项系统综述,以收集有关已记录的、可增加撒哈拉以南非洲城市地区艾滋病毒感染者(PLHIV)与护理机构建立联系的策略的信息。在Scopus、Cochrane中心、CINAHL Plus、PubMed和OpenGrey上进行了电子检索,查找2006年以来实施的联系策略。共识别出189条潜在相关引文,其中7条符合纳入标准。使用文献中的主题对识别出的策略进行分类。最常见的策略包括:卫生系统干预措施(即综合护理、任务转移);患者便利性和可及性(即立即进行CD4细胞计数检测、立即启动抗逆转录病毒疗法、社区艾滋病毒检测);行为干预和同伴支持(即辅助性伴侣服务、护理便利化、手机预约提醒、健康教育)以及激励措施(即非现金经济激励和交通费用报销)。几种策略显示出良好效果:综合护理、立即进行CD4细胞计数检测、立即启动抗逆转录病毒疗法以及辅助性伴侣服务。辅助性伴侣服务、当日居家启动抗逆转录病毒疗法、联合干预策略以及即时护理点CD4检测显著改善了撒哈拉以南非洲地区城市环境中与护理机构的联系。这些措施可以在医疗机构或社区实施,但应由卫生工作者提供便利。然而,该次区域需要开展更多针对建立联系的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e31f/6898990/625673a6a237/HIV-11-321-g0001.jpg

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