Kisumu County Department of Health, Kisumu, Kenya.
37463Institute of Tropical Medicine, Antwerp, Belgium.
Int J STD AIDS. 2022 Apr;33(5):485-491. doi: 10.1177/09564624221076953. Epub 2022 Feb 28.
HIV testing efficiency could be improved by focusing on high yield populations and identifying types of health facilities where people with undiagnosed HIV infection are more likely to attend.
A retrospective cohort analysis of data collected during an integrated TB/HIV active case-finding intervention in Western Kenya. Data were analyzed from health facilities' registers on individuals who reported TB-suggestive symptoms between 1 July and 31 December 2018 and who had an HIV test result within one month following symptom screening. We used logistic regression with general estimating equations adjusting for sub-county level data to identify health facility-level predictors of new HIV diagnoses.
Of 11,376 adults with presumptive TB identified in 143 health facilities, 1038 (9%) tested HIV positive. The median HIV positivity per health facility was 6% (IQR = 2-15%). Patients with TB symptoms were over three times as likely to have a new HIV diagnosis in private not-for-profit facilities compared to those in government facilities (adjusted odds ratio (aOR) 3.40; 95% CI = 1.96-5.90). Patients tested in hospitals were over two times as likely to have a new HIV diagnosis as those tested in smaller facilities (i.e., health centers and dispensaries) (aOR 2.26; 95% CI = 1.60-3.21).
Individuals with presumptive TB who attended larger health facilities and private not-for-profit facilities had a higher likelihood of being newly diagnosed with HIV. Strengthening HIV services at these facilities and outreach to populations that use them could help to close the HIV diagnosis gap.
通过关注高产出人群并确定未确诊 HIV 感染者更有可能就诊的卫生机构类型，可以提高 HIV 检测效率。
对肯尼亚西部一项整合结核病/艾滋病主动病例发现干预措施期间收集的数据进行回顾性队列分析。对 2018 年 7 月 1 日至 12 月 31 日期间报告有疑似结核病症状且在症状筛查后一个月内进行 HIV 检测的个人的卫生机构登记册中的数据进行分析。我们使用具有广义估计方程的逻辑回归来调整县级以下数据，以确定新的 HIV 诊断的卫生机构水平预测因素。
在 143 家卫生机构中发现了 11376 名疑似结核病的成年人，其中 1038 人（9%）HIV 检测呈阳性。每个卫生机构的 HIV 阳性率中位数为 6%（IQR=2-15%）。与政府机构相比，私营非营利机构的结核病症状患者新诊断 HIV 的可能性是政府机构的三倍以上（调整后的优势比（aOR）为 3.40；95%CI=1.96-5.90）。在医院接受检测的患者新诊断 HIV 的可能性是在较小设施（即卫生中心和诊所）接受检测的患者的两倍多（aOR 2.26；95%CI=1.60-3.21）。
患有疑似结核病且就诊于较大卫生机构和私营非营利机构的个体更有可能被新诊断出 HIV。加强这些机构的 HIV 服务并向使用这些机构的人群开展宣传，可以帮助缩小 HIV 诊断差距。
