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缩小差距:在赞比亚 HPTN 071(PopART)试验期间和之后,与基于家庭的检测互补的分娩方法是否覆盖了艾滋病毒检测服务中的男性?

Closing the gap: did delivery approaches complementary to home-based testing reach men with HIV testing services during and after the HPTN 071 (PopART) trial in Zambia?

机构信息

Zambart, Lusaka, Zambia.

Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.

出版信息

J Int AIDS Soc. 2022 Jan;25(1):e25855. doi: 10.1002/jia2.25855.


DOI:10.1002/jia2.25855
PMID:35001530
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8743361/
Abstract

INTRODUCTION: The HPTN 071 (PopART) trial demonstrated that universal HIV testing-and-treatment reduced community-level HIV incidence. Door-to-door delivery of HIV testing services (HTS) was one of the main components of the intervention. From an early stage, men were less likely to know their HIV status than women, primarily because they were not home during service delivery. To reach more men, different strategies were implemented during the trial. We present the relative contribution of these strategies to coverage of HTS and the impact of community hubs implemented after completion of the trial among men. METHODS: Between 2013 and 2017, three intervention rounds (IRs) of door-to-door HTS delivery were conducted in eight PopART communities in Zambia. Additional strategies implemented in parallel, included: community-wide "Man-up" campaigns (IR1), smaller HTS campaigns at work/social places (IR2) and revisits to households with the option of HIV self-testing (HIVST) (IR3). In 2018, community "hubs" offering HTS were implemented for 7 months in all eight communities. Population enumeration data for each round of HTS provided the denominator, allowing for calculation of the proportion of men tested as a result of each strategy during different time periods. RESULTS: By the end of the three IRs, 65-75% of men were reached with HTS, primarily through door-to-door service delivery. In IR1 and IR2, "Man-up" and work/social place campaigns accounted for ∼1 percentage point each and in IR3, revisits with the option of self-testing for ∼15 percentage points of this total coverage per IR. The yield of newly diagnosed HIV-positive men ranged from 2.2% for HIVST revisits to 9.9% in work/social places. At community hubs, the majority of visitors accepting services were men (62.8%). In total, we estimated that ∼36% (2.2% tested HIV positive) of men resident but not found at their household during IR3 of PopART accessed HTS provided at the hubs after trial completion. CONCLUSIONS: Achieving high coverage of HTS among men requires universal, home-based service delivery combined with an option of HIVST and delivery of HTS through community-based hubs. When men are reached, they are willing to test for HIV. Reaching men thus requires implementers to adapt their HTS delivery strategies to meet men's needs. CLINICAL TRIAL NUMBER: NCT01900977.

摘要

简介:HPTN 071(PopART)试验表明,普遍进行 HIV 检测和治疗可降低社区层面的 HIV 发病率。挨家挨户提供 HIV 检测服务(HTS)是干预措施的主要组成部分之一。从早期开始,男性就比女性更不可能了解自己的 HIV 状况,主要是因为他们在服务提供期间不在家。为了接触到更多的男性,试验期间实施了不同的策略。我们介绍了这些策略对 HTS 覆盖率的相对贡献,以及试验完成后在社区中心实施这些策略对男性的影响。

方法:2013 年至 2017 年,在赞比亚的八个 PopART 社区进行了三轮(IR)挨家挨户的 HTS 交付干预。同时实施了其他并行策略,包括:社区范围的“男子汉”运动(IR1)、工作/社交场所的小型 HTS 运动(IR2)以及对有 HIV 自检选项的家庭进行回访(IR3)。2018 年,在所有八个社区实施了为期 7 个月的社区“中心”提供 HTS。每次 HTS 的人口普查数据都为分母提供了依据,从而可以计算出在不同时期每种策略导致的男性接受检测的比例。

结果:三轮 HTS 结束后,65-75%的男性接受了 HTS,主要通过上门服务提供。在 IR1 和 IR2 中,“男子汉”和工作/社交场所运动各占 1 个百分点,而在 IR3 中,回访并提供自检选项占总覆盖率的 15 个百分点。新诊断为 HIV 阳性的男性比例范围从 HIVST 回访的 2.2%到工作/社交场所的 9.9%。在社区中心,接受服务的大多数访客都是男性(62.8%)。总的来说,我们估计,在 PopARTIR3 期间,居住在社区但在其家庭中未被发现的男性中有约 36%(2.2%检测呈 HIV 阳性)接受了试验完成后在中心提供的 HTS。

结论:要实现男性 HTS 的高覆盖率,需要普遍、以家庭为基础的服务提供,同时提供 HIVST 选项,并通过社区中心提供 HTS。当接触到男性时,他们愿意接受 HIV 检测。因此,要接触到男性,实施者需要调整其 HTS 提供策略以满足男性的需求。

临床试验编号:NCT01900977。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee7f/8743361/e7b95d404cea/JIA2-25-e25855-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee7f/8743361/e1051ebc5158/JIA2-25-e25855-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee7f/8743361/2f4486114d5d/JIA2-25-e25855-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee7f/8743361/e7b95d404cea/JIA2-25-e25855-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee7f/8743361/e1051ebc5158/JIA2-25-e25855-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee7f/8743361/2f4486114d5d/JIA2-25-e25855-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee7f/8743361/e7b95d404cea/JIA2-25-e25855-g002.jpg

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本文引用的文献

[1]
Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial.

Lancet Glob Health. 2021-5

[2]
Strategies for engaging men in HIV services.

Lancet HIV. 2019-2-15

[3]
Community based distribution of oral HIV self-testing kits in Zambia: a cluster-randomised trial nested in four HPTN 071 (PopART) intervention communities.

Lancet HIV. 2018-12-21

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AIDS. 2017-7-17

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A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial.

PLoS Med. 2017-5-2

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Community-based strategies to strengthen men's engagement in the HIV care cascade in sub-Saharan Africa.

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