ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia.
Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia.
PLoS One. 2021 Aug 11;16(8):e0255163. doi: 10.1371/journal.pone.0255163. eCollection 2021.
The HIV epidemic in Ethiopia is concentrated in urban areas. Ethiopia conducted a Population-based HIV Impact Assessment (EPHIA) in urban areas between October 2017 and April 2018 to measure the status of the country's response to the epidemic.
We conducted field data collection and HIV testing in randomly selected households using the national, rapid testing algorithm with laboratory confirmation of seropositive samples using a supplemental assay. In addition to self-report on HIV diagnosis and treatment, all HIV-positive participants were screened for a set of HIV antiretroviral (ARV) drugs indicative of the first- and second-line regimens. We calculated weighted frequencies and 95% confidence intervals to assess regional variation in participants' level of unawareness of their HIV-positive status (adjusted for ARV status).
We interviewed 20,170 survey participants 15-64 years of age, of which 19,136 (95%) were tested for HIV, 614 (3.2%) tested positive, and 119 (21%) of HIV-positive persons were unaware of their HIV status. Progress towards the UNAIDS first 90 target (90% of people living with HIV would be aware of their HIV status by 2020) substantially differed by administrative region of the country. In the bivariate analysis using log binomial regression, three regions (Oromia, Addis Ababa, and Harari), male gender, and young age (15-24 years) were significantly associated with awareness of HIV positive status. In multivariate analysis, the same variables were associated with awareness of HIV-positive status.
One-fifth of the HIV-positive urban population were unaware of their HIV-positive status. The number of unaware HIV-positive individuals has a different distribution than the HIV prevalence. National and regional planning and monitoring activities could address this potentially substantial source of undetected HIV infection by increasing HIV testing among young people, men and individuals who do not use condoms.
埃塞俄比亚的艾滋病疫情集中在城市地区。埃塞俄比亚于 2017 年 10 月至 2018 年 4 月期间在城市地区开展了一项基于人群的艾滋病影响评估（EPHIA），以衡量该国对疫情的应对情况。
我们在随机选择的家庭中使用国家快速检测算法进行现场数据收集和 HIV 检测，并对阳性血清样本进行实验室确认，采用补充检测方法。除了自我报告的艾滋病诊断和治疗外，所有 HIV 阳性参与者都接受了一套 HIV 抗逆转录病毒（ARV）药物的筛查，以表明一线和二线方案。我们计算了加权频率和 95%置信区间，以评估参与者对其 HIV 阳性状态的认识程度在地区上的差异（调整了 ARV 状况）。
我们采访了 20170 名年龄在 15-64 岁的调查参与者，其中 19136 人（95%）接受了 HIV 检测，614 人（3.2%）检测呈阳性，119 人（21%）HIV 阳性者不知道自己的 HIV 状况。朝着联合国艾滋病规划署（UNAIDS）的第一个 90 目标（到 2020 年，90%的艾滋病毒感染者将了解自己的艾滋病毒状况）的进展因国家的行政区域而有很大的不同。在使用对数二项回归的双变量分析中，三个地区（奥罗莫、亚的斯亚贝巴和哈拉里）、男性和年轻（15-24 岁）与知晓 HIV 阳性状态显著相关。在多变量分析中，同样的变量与知晓 HIV 阳性状态相关。
五分之一的城市 HIV 阳性人群不知道自己的 HIV 阳性状态。不知道 HIV 阳性状态的 HIV 阳性者人数与 HIV 流行率的分布不同。国家和地区的规划和监测活动可以通过增加年轻人、男性和不使用安全套者的 HIV 检测，解决这一潜在的大量未被发现的 HIV 感染源。
