Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia.
Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.
J Int AIDS Soc. 2020 Jun;23 Suppl 2(Suppl 2):e25520. doi: 10.1002/jia2.25520.
Current healthcare systems fail to provide adequate HIV services to men. In Zambia, 25% of adult men living with HIV were unaware of their HIV status in 2018, and 12% of those who were unaware of their HIV statu were not receiving antiretroviral therapy (ART) due to pervasive barriers to HIV testing services (HTS) and linkage to ART. To identify men and key and priority populations living with HIV in Zambia, and link them to care and treatment, we implemented the Community Impact to Reach Key and Underserved Individuals for Treatment and Support (CIRKUITS) project. We present HTS and ART linkage results from the first year of CIRKUITS.
CIRKUITS aimed to reach beneficiaries by training, mentoring, and deploying community health workers to provide index testing services and targeted community HTS. Community leaders and workplace supervisors were engaged to enable workplace HTS for men. To evaluate the effects of these interventions, we collected age- and sex-disaggregated routinely collected programme data for the first 12 months of the project (October 2018 to September 2019) across 37 CIRKUITS-supported facilities in three provinces. We performed descriptive statistics and estimated index cascades for indicators of interest, and used Chi square tests to compare indicators by age, sex, and district strata.
Over 12 months, CIRKUITS tested 38,255 persons for HIV, identifying 10,974 (29%) new people living with HIV, of whom 10,239 (93%) were linked to ART. Among men, CIRKUITS tested 18,336 clients and identified 4458 (24%) as HIV positive, linked 4132 (93%) to ART. Men who tested HIV negative were referred to preventative services. Of the men found HIV positive, and 13.0% were aged 15 to 24 years, 60.3% were aged 25 to 39, 20.9% were aged 40 to 49 and 5.8% were ≥50 years old. Index testing services identified 2186 (49%) of HIV-positive men, with a positivity yield of 40% and linkage of 88%. Targeted community testing modalities accounted for 2272 (51%) of HIV-positive men identified, with positivity yield of 17% and linkage of 97%.
Index testing and targeted community-based HTS are effective strategies to identify men living with HIV in Zambia. Index testing results in higher yield, but lower linkage and fewer absolute men identified compared to targeted community-based HTS.
当前的医疗体系未能为男性提供足够的艾滋病服务。2018 年，赞比亚 25%的成年男性不知道自己的艾滋病毒状况，而在不知道自己艾滋病毒状况的人中，有 12%的人没有接受抗逆转录病毒治疗（ART），这是由于艾滋病病毒检测服务（HTS）和与 ART 衔接的普遍障碍。为了发现和联系赞比亚的男性以及关键和优先人群中的艾滋病毒感染者，并为他们提供治疗和护理，我们实施了社区影响以覆盖关键和服务不足的个人接受治疗和支持（CIRKUITS）项目。我们展示了 CIRKUITS 项目第一年的 HTS 和 ART 衔接结果。
CIRKUITS 的目标是通过培训、指导和部署社区卫生工作者，为目标人群提供索引检测服务和有针对性的社区 HTS，从而覆盖到受益人。社区领导人和工作场所主管被动员起来，为男性提供工作场所 HTS。为了评估这些干预措施的效果，我们收集了项目开始后前 12 个月（2018 年 10 月至 2019 年 9 月）在三个省的 37 个 CIRKUITS 支持的设施中按年龄和性别分类的常规收集项目数据。我们对感兴趣的指标进行了描述性统计和指标级联估计，并使用卡方检验比较了按年龄、性别和地区分层的指标。
在 12 个月期间，CIRKUITS 对 38255 人进行了艾滋病毒检测，发现 10974 人（29%）为新的艾滋病毒感染者，其中 10239 人（93%）被链接到 ART。在男性中，CIRKUITS 对 18336 名客户进行了检测，发现 4458 人（24%）为艾滋病毒阳性，其中 4132 人（93%）被链接到 ART。艾滋病毒检测阴性的男性被转介到预防服务。在发现的艾滋病毒阳性男性中，有 13.0%的年龄在 15 至 24 岁之间，60.3%的年龄在 25 至 39 岁之间，20.9%的年龄在 40 至 49 岁之间，5.8%的年龄在 50 岁以上。索引检测服务发现了 2186 名（49%）艾滋病毒阳性男性，阳性率为 40%，衔接率为 88%。有针对性的社区检测模式发现了 2272 名（51%）艾滋病毒阳性男性，阳性率为 17%，衔接率为 97%。
索引检测和基于社区的针对性 HTS 是在赞比亚发现男性艾滋病毒感染者的有效策略。与基于社区的针对性 HTS 相比，索引检测的结果阳性率更高，但衔接率和绝对发现的男性人数较低。
