为服务不足的南非人提供综合性慢性疾病筛查和移动艾滋病毒咨询及检测：开普敦开展的回顾性纵向研究。
Reaching underserved South Africans with integrated chronic disease screening and mobile HIV counselling and testing: A retrospective, longitudinal study conducted in Cape Town.
机构信息
Faculty of Health Sciences, The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America.
出版信息
PLoS One. 2021 May 4;16(5):e0249600. doi: 10.1371/journal.pone.0249600. eCollection 2021.
BACKGROUND
Community-based, mobile HIV counselling and testing (HCT) and screening for non-communicable diseases (NCDs) may improve early diagnosis and referral for care in underserved populations. We evaluated HCT/NCD data and described population characteristics of those visiting a mobile clinic in high HIV disease burden settings in Cape Town, South Africa, between 2008 and 2016.
METHODS
Trained counsellors registered patients ≥12 years old at a mobile clinic, which offered HCT and blood pressure, diabetes (glucose testing) and obesity (body mass index) screening. A nurse referred patients who required HIV treatment or NCD care. Using multivariable logistic regression, we estimated correlates of new HIV diagnoses adjusting for gender, age and year.
RESULTS
Overall, 43,938 individuals (50% male; 29% <25 years; median age = 31 years) tested for HIV at the mobile clinic, where 27% of patients (66% of males, 34% of females) reported being debut HIV testers. Males not previously tested for HIV had higher rates of HIV positivity (11%) than females (7%). Over half (55%, n = 1,343) of those previously diagnosed HIV-positive had not initiated ART. More than one-quarter (26%) of patients screened positive for hypertension (males 28%, females 24%, p<0.001). Females were more likely overweight (25% vs 20%) or obese (43% vs 9%) and presented with more diabetes symptoms than males (8% vs 4%). Females (3%) reported more symptoms of STIs than males (1%). Reporting symptoms of sexually transmitted infections (aOR = 3.45, 95% CI = 2.84, 4.20), diabetes symptoms (aOR = 1.61, 95% 1.35, 1.92), and TB symptoms (aOR = 4.40, 95% CI = 3.85, 5.01) were associated with higher odds of a new HIV diagnosis after adjusting for covariates.
CONCLUSION
Findings demonstrate that mobile clinics providing integrated HCT and NCD screening may offer the opportunity of early diagnosis and referral for care for those who delay screening, including men living with HIV not previously tested.
背景
基于社区的移动艾滋病毒咨询和检测（HCT）以及非传染性疾病（NCD）筛查可能会改善在服务不足人群中的早期诊断和护理转介。我们评估了 HCT/NCD 数据，并描述了 2008 年至 2016 年间在南非开普敦艾滋病毒疾病负担高的环境中，到移动诊所就诊的人群特征。
方法
在移动诊所，经过培训的咨询师为年龄≥12 岁的患者进行登记，提供 HCT 服务以及血压、糖尿病（血糖检测）和肥胖（体重指数）筛查。护士将需要艾滋病毒治疗或 NCD 护理的患者转介。我们使用多变量逻辑回归，在调整性别、年龄和年份后，估计新艾滋病毒诊断的相关因素。
结果
总体而言，有 43938 人（50%为男性；29%年龄<25 岁；中位数年龄为 31 岁）在移动诊所接受了 HIV 检测，其中 27%的患者（66%为男性，34%为女性）报告为首次进行 HIV 检测。以前未接受过 HIV 检测的男性艾滋病毒阳性率（11%）高于女性（7%）。超过一半（55%，n=1343）以前诊断为 HIV 阳性的人尚未开始接受抗逆转录病毒治疗。超过四分之一（26%）的患者筛查出高血压阳性（男性 28%，女性 24%，p<0.001）。女性超重（25%）或肥胖（43%）的可能性高于男性（20%或 9%），并且出现糖尿病症状的可能性高于男性（8%对 4%）。女性（3%）比男性（1%）报告的性传播感染症状更多。报告有性传播感染症状（优势比[OR] = 3.45，95%置信区间[CI] = 2.84，4.20）、糖尿病症状（OR = 1.61，95%置信区间[CI] = 1.35，1.92）和结核病症状（OR = 4.40，95%置信区间[CI] = 3.85，5.01）与调整了混杂因素后的新 HIV 诊断几率更高相关。
结论
研究结果表明，提供综合 HCT 和 NCD 筛查的移动诊所可能为那些延迟筛查的人提供早期诊断和护理转介的机会，包括以前未接受过检测的 HIV 感染者。
Zotero 插件