Division of Global HIV and TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
U.S. Centers for Disease Control and Prevention, Maputo, Mozambique.
PLoS One. 2020 Nov 20;15(11):e0242281. doi: 10.1371/journal.pone.0242281. eCollection 2020.
HIV prevalence in Mozambique (12.6%) is one of the highest in the world, yet ~40% of people living with HIV (PLHIV) do not know their HIV status. Strategies to increase HIV testing uptake and diagnosis among PLHIV are urgently needed. Home-based HIV testing services (HBHTS) have been evaluated primarily as a 1-time campaign strategy. Little is known about the potential of repeating HBHTS to diagnose HIV infection among persons who have never been tested (NTs), nor about factors/reasons associated with never testing in a generalized epidemic setting.
During 2014-2017, counselors visited all households annually in the Chókwè Health and Demographic Surveillance System (CHDSS) and offered HBHTS. Cross-sectional surveys were administered to randomly selected 10% or 20% samples of CHDSS households with participants aged 15-59 years before HBHTS were conducted during the visit. Descriptive statistics and logistic regression were used to assess the proportion of NTs, factors/reasons associated with never having been tested, HBHTS acceptance, and HIV-positive diagnosis among NTs.
The proportion of NTs decreased from 25% (95% confidence interval [CI]:23%-26%) during 2014 to 12% (95% CI:11% -13%), 7% (95% CI:6%-8%), and 7% (95% CI:6%-8%) during 2015, 2016, and 2017, respectively. Adolescent boys and girls and adult men were more likely than adult women to be NTs. In each of the four years, the majority of NTs (87%-90%) accepted HBHTS. HIV-positive yield among NTs subsequently accepting HBHTS was highest (13%, 95% CI:10%-15%) during 2014 and gradually reduced to 11% (95% CI:8%-15%), 9% (95% CI:6%-12%), and 2% (95% CI:0%-4%) during 2015, 2016, and 2017, respectively.
Repeated HBHTS was helpful in increasing HIV testing coverage and identifying PLHIV in Chókwè. In high HIV-prevalence settings with low testing coverage, repeated HBHTS can be considered to increase HIV testing uptake and diagnosis among NTs.
莫桑比克的艾滋病毒流行率（12.6%）是世界上最高的国家之一，但仍有~40%的艾滋病毒感染者（PLHIV）不知道自己的艾滋病毒状况。迫切需要采取策略来提高 PLHIV 的艾滋病毒检测率和诊断率。家庭为基础的艾滋病毒检测服务（HBHTS）主要被评估为一次性的宣传策略。在普遍流行的情况下，很少有人知道重复 HBHTS 检测是否可以诊断从未接受过检测的人（NTs）的艾滋病毒感染，也不知道与从未接受过检测相关的因素/原因。
在 2014 年至 2017 年期间，顾问每年都会访问 Chókwè 卫生和人口监测系统（CHDSS）的所有家庭，并提供 HBHTS。在访问期间进行 HBHTS 之前，对 CHDSS 家庭中随机抽取 10%或 20%的样本进行横断面调查，参与者年龄在 15-59 岁之间。使用描述性统计和逻辑回归评估从未接受过检测的 NTs 的比例、与从未接受过检测相关的因素/原因、HBHTS 的接受率和 NTs 中的艾滋病毒阳性诊断率。
从未接受过检测的 NTs 的比例从 2014 年的 25%（95%置信区间[CI]：23%-26%）下降到 2015 年的 12%（95% CI：11%-13%）、7%（95% CI：6%-8%）和 7%（95% CI：6%-8%）、2016 年和 2017 年分别为 7%（95% CI：6%-8%）。青少年男孩和女孩以及成年男性比成年女性更有可能成为 NTs。在这四年中的每一年，大多数 NTs（87%-90%）都接受了 HBHTS。随后接受 HBHTS 的 NTs 的艾滋病毒阳性检出率最高（13%，95%CI：10%-15%），随后逐年下降至 2014 年的 11%（95%CI：8%-15%）、2015 年的 9%（95%CI：6%-12%）、2016 年的 9%（95%CI：6%-12%）和 2017 年的 2%（95%CI：0%-4%）。
重复 HBHTS 有助于提高艾滋病毒检测覆盖率和发现 Chókwè 的 PLHIV。在艾滋病毒流行率高、检测覆盖率低的情况下，可以考虑重复 HBHTS 来提高 NTs 的艾滋病毒检测率和诊断率。
