Division of Global HIV and TB, Center for Global Health, CDC.
ASPPH/PHI/CDC HIV Surveillance Fellowship.
J Acquir Immune Defic Syndr. 2021 Aug 1;87(Suppl 1):S97-S106. doi: 10.1097/QAI.0000000000002708.
BACKGROUND: Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15-59 years who ever tested for HIV in 13 SSA countries. METHODS: Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV. RESULTS: A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%-58.7%, in Rwanda and Cote d'Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity. CONCLUSION: Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services.
背景:在撒哈拉以南非洲(SSA)识别感染艾滋病毒的男性对于终结艾滋病流行至关重要。我们描述了在 13 个 SSA 国家中曾接受过艾滋病毒检测的 15-59 岁男性中,对艾滋病毒检测呈阳性而不知情的潜在因素。
方法:使用全国代表性的基于人群的艾滋病毒影响评估的汇总数据,我们拟合了一个对数二项式回归模型,以确定与艾滋病毒检测呈阳性但不知晓其艾滋病毒状况的艾滋病毒阳性和阴性男性相关的特征。
结果:共有 114776 名男性接受了访谈和艾滋病毒检测;4.4%为艾滋病毒阳性。其中,33.7%的人不知道自己的艾滋病毒阳性状态(范围:20.2%-58.7%,在卢旺达和科特迪瓦)。大多数不知晓的男性报告说他们曾接受过艾滋病毒检测(63.0%)。年龄、地区、婚姻状况和教育程度与艾滋病毒阳性显著相关。与艾滋病毒阳性性伴侣(调整后的患病率比 [aPR]:5.73;95%CI:4.13 至 7.95)或性伴侣艾滋病毒状况未知(aPR:2.32;95%CI:1.89 至 2.84)的男性更有可能为艾滋病毒检测呈阳性而不知晓,与在访谈前 12 个月内接受过检测且 HIV 检测呈阴性的男性相比,在 12 个月以上接受过检测的男性(aPR:1.58;95%CI:1.31 至 1.91)也更有可能为艾滋病毒检测呈阳性而不知晓。结核病诊断和未行割礼也与艾滋病毒阳性相关。
结论:针对曾经检测为阴性但有感染风险的男性亚群进行目标检测,可能会提高检测项目的效果。干预措施包括改进伴侣检测、检测频率、外展和教育策略,以及在男性接受常规卫生服务的地方提供艾滋病毒检测。
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