Department of Global Health, University of Washington, Seattle, WA.
Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2020 Dec 1;85(4):399-407. doi: 10.1097/QAI.0000000000002469.
BACKGROUND: Despite a doubling of HIV testing coverage in Kenya over the past decade, approximately 2 in 10 people with HIV remained unaware of their infection in 2018. HIV testing is most effective in identifying people with undiagnosed HIV through frequent and strategic testing in populations at high risk. An assessment of testing frequency and predictors of first-time and repeat testing is critical for monitoring effectiveness of testing strategies. METHODS: We conducted a cross-sectional analysis of adults aged ≥18 years who tested HIV-positive at 4 HIV testing and counseling clinics in Kenya from February 2015 to February 2016. We categorized individuals based on testing history, used Wilcoxon rank-sum tests to assess differences in intervals between the most recent and current HIV test, and used log-binomial regression to determine characteristics associated with first-time and repeat testing. RESULTS: Among 1136 people testing HIV-positive, 336 (30%) had never tested before and 800 (70%) had, of whom 208 (26%) had previously tested positive. Among previously negative repeat testers, the median intertest interval was 414 days in key/priority populations (interquartile range = 179-1072) vs. 538 in the general population (interquartile range = 228-1299) (P = 0.09). Compared with previously negative repeat testers, being a first-time tester was associated with being age ≥40 years [vs. 18-24; adjusted risk ratio = 1.67, 95% confidence interval (CI): 1.23 to 2.26], men (vs. women; adjusted risk ratio = 1.45, 95% CI: 1.21 to 1.71), and testing through provider-initiated testing and counseling (vs. client initiated; 1.19, 95% CI: 1.00 to 1.40). CONCLUSIONS: There is a need to increase HIV testing among older individuals and men, increase testing frequency in key/priority populations, and maintain provider-initiated and facility-based testing to reach first-time testers.
背景:尽管肯尼亚在过去十年中艾滋病毒检测覆盖率翻了一番,但 2018 年仍有约 20%的艾滋病毒感染者不知道自己已感染艾滋病毒。艾滋病毒检测通过在高危人群中进行频繁和有策略的检测,最有效地发现未被诊断的艾滋病毒感染者。评估检测频率和首次及重复检测的预测因素对于监测检测策略的效果至关重要。
方法:我们对 2015 年 2 月至 2016 年 2 月在肯尼亚 4 个艾滋病毒检测和咨询诊所检测艾滋病毒呈阳性的年龄≥18 岁的成年人进行了横断面分析。我们根据检测史对个体进行分类,使用 Wilcoxon 秩和检验评估最近一次和当前艾滋病毒检测之间的时间间隔差异,并使用对数二项式回归确定与首次和重复检测相关的特征。
结果:在 1136 名艾滋病毒检测呈阳性的人中,336 人(30%)从未检测过,800 人(70%)检测过,其中 208 人(26%)此前检测呈阳性。在以前阴性的重复检测者中,关键/优先人群的中位检测间隔为 414 天(四分位距=179-1072),而一般人群的中位检测间隔为 538 天(四分位距=228-1299)(P=0.09)。与以前阴性的重复检测者相比,首次检测者的年龄≥40 岁(18-24 岁)[调整后的风险比=1.67,95%置信区间(CI):1.23-2.26]、男性(女性)[调整后的风险比=1.45,95%置信区间(CI):1.21-1.71]和通过提供者启动的检测和咨询进行检测(客户启动)[调整后的风险比=1.19,95%置信区间(CI):1.00-1.40]的可能性更高。
结论:需要增加老年人和男性的艾滋病毒检测,增加关键/优先人群的检测频率,并保持提供者启动和基于设施的检测,以发现首次检测者。
J Acquir Immune Defic Syndr. 2020-12-1