Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2021 Apr 30;111(5):460-468. doi: 10.7196/SAMJ.2021.v111i5.15351.
Health service coverage cascades measure the proportion of a population in need of a service that experienced a positive health outcome from the service, and enable tracking of progress in achieving universal health coverage and inequities in care coverage.
To investigate HIV care coverage among HIV-positive adolescent girls and young women (AGYW) living in six South African districts, compare coverage by age and socioeconomic status (SES), and investigate other associated factors including participation in a combination HIV prevention intervention.
The HERStory Study was an evaluation of the combination intervention, comprising a representative household survey of AGYW aged 15 - 24 years living in six intervention districts. From September 2017 to November 2018, biological, sociodemographic and behavioural data were collected. HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression were determined through laboratory tests (enzyme-linked immunosorbent assay for HIV antibodies, antiretroviral (ARV) metabolites and viral load (VL) testing). Viral suppression was defined as a VL <1 000 copies/mL. Knowledge of HIV-positive status was self-reported, and participants testing positive for ARV metabolites were assumed to have known their HIV-positive status. Unconditional HIV care cascades were created, stratified by age and SES. We used Pearson's χ2 tests corrected for survey-based analysis to describe factors associated with knowledge of HIV status, and being on ART.
Of the 4 399 participants, 568 were HIV-positive (12.4%), of whom 60.8% (95% confidence interval (CI) 57.1 - 64.5) knew their status, 50.6% (95% CI 46.6 - 54.0) were on ART, and 62.1% (95% CI 58.4 - 65.9) were virally suppressed. Most participants (84.9%) were in the lower SES group, and they had better coverage than the higher SES group: 61.9% (95% CI 58.3 - 65.4) knew their status, 52.1% (95% CI 48.4 - 55.9) were on ART, and 64.9% (95% CI 61.3 - 68.4) were virally suppressed, compared with 55.0% (95% CI 42.1 - 68.0), 40.0% (95% CI 29.2 - 50.8), and 46.6% (95% CI 34.5 - 58.7), respectively. Participants aged 15 - 19 years had slightly inferior coverage to the 20 - 24-year-old group: 57.5% knew their status, 46.1% were on ART and 59.5% were virally suppressed, compared with 62.3%, 52.2% and 63.3%.
These findings emphasise the need to close the gaps in HIV care coverage among AGYW, of whom only 61% knew their HIV-positive status and only 62% were virally suppressed. There is pro-poor inequality in HIV care coverage, with those in lower socioeconomic groups more likely to be virally suppressed.
卫生服务覆盖范围梯级衡量了需要服务的人群中，实际从服务中获得积极健康结果的比例，从而能够跟踪实现全民健康覆盖和护理覆盖不平等方面的进展。
调查在南非六个地区居住的艾滋病毒阳性青少年女孩和年轻妇女（AGYW）的艾滋病毒护理覆盖率，按年龄和社会经济地位（SES）进行比较，并调查其他相关因素，包括参与组合艾滋病毒预防干预措施的情况。
HERStory 研究是对组合干预措施的评估，包括对居住在六个干预地区的年龄在 15-24 岁的 AGYW 进行具有代表性的家庭调查。从 2017 年 9 月至 2018 年 11 月，收集了生物、社会人口学和行为数据。通过实验室检测（艾滋病毒抗体酶联免疫吸附试验、抗逆转录病毒（ARV）代谢物和病毒载量（VL）检测）确定 HIV 阳性状态、开始抗逆转录病毒治疗（ART）和病毒抑制情况。病毒抑制定义为 VL <1000 拷贝/ml。HIV 阳性状态的知识是自我报告的，检测到 ARV 代谢物阳性的参与者被假定为已知其 HIV 阳性状态。按年龄和 SES 分层创建了无条件的 HIV 护理级联。我们使用 Pearson χ2 检验校正基于调查的分析来描述与 HIV 状态知识和接受 ART 相关的因素。
在 4399 名参与者中，有 568 人（12.4%）为 HIV 阳性，其中 60.8%（95%置信区间（CI）为 57.1-64.5）知道自己的状态，50.6%（95% CI 为 46.6-54.0）正在接受 ART，62.1%（95% CI 为 58.4-65.9）病毒得到抑制。大多数参与者（84.9%）属于较低 SES 群体，他们的覆盖率高于较高 SES 群体：61.9%（95% CI 为 58.3-65.4）知道自己的状态，52.1%（95% CI 为 48.4-55.9）正在接受 ART，64.9%（95% CI 为 61.3-68.4）病毒得到抑制，而较高 SES 群体的比例分别为 55.0%（95% CI 为 42.1-68.0）、40.0%（95% CI 为 29.2-50.8）和 46.6%（95% CI 为 34.5-58.7）。15-19 岁的参与者的 HIV 护理覆盖率略低于 20-24 岁的参与者：57.5%的人知道自己的状态，46.1%的人接受了 ART，59.5%的人病毒得到抑制，而 62.3%、52.2%和 63.3%的人则分别为 62.3%、52.2%和 63.3%。
这些发现强调了需要缩小 AGYW 中 HIV 护理覆盖范围的差距，其中只有 61%的人知道自己的 HIV 阳性状态，只有 62%的人病毒得到抑制。在 HIV 护理覆盖范围方面存在有利于贫困人群的不平等现象，社会经济地位较低的人群更有可能实现病毒抑制。
