撒哈拉以南非洲四个高艾滋病毒流行地区血清不一致夫妇中的艾滋病毒护理连续体。

The HIV cascade of care among serodiscordant couples in four high HIV prevalence settings in sub-Saharan Africa.

机构信息

School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Epicentre, Cape Town, South Africa.

出版信息

S Afr Med J. 2021 Aug 2;111(8):768-776. doi: 10.7196/SAMJ.2021.v111i8.15489.

DOI:10.7196/SAMJ.2021.v111i8.15489

PMID:35227358

Abstract

BACKGROUND

HIV-serodiscordant couples are at high risk of HIV transmission. In sub-Saharan Africa, HIV-serodiscordant couples contribute ~30% of all new infections in the region.

OBJECTIVES

To quantify the prevalence of HIV-serodiscordant couples and evaluate steps of the HIV cascade of care among people living with HIV in serodiscordant relationships in four high-prevalence settings in sub-Saharan Africa.

METHODS

Four HIV prevalence surveys were conducted: in Ndhiwa (Kenya) in 2012, in Chiradzulu (Malawi) in 2013, and in Gutu (Zimbabwe) and Nsanje (Malawi) in 2016. Eligible individuals aged 15 - 59 years were asked to participate in voluntary rapid HIV testing. Viral load and CD4 counts were measured on those who tested HIV-positive. A couple was defined as a man and a woman who reported being married or cohabiting and were living together in the same household.

RESULTS

Among 4 385 couples, the prevalence of HIV serodiscordancy was 10.9% (95% confidence interval (CI) 10.2 - 11.5) overall, ranging from 6.7% (95% CI 5.6 - 7.9) in Nsanje to 15.8% (95% CI 14.5 - 17.3) in Ndhiwa. Men were the HIV-positive partner in 62.7% of the serodiscordant couples in Ndhiwa, in 60.4% in Gutu, in 48.8% in Chiradzulu and in 50.9% in Nsanje. Status awareness among HIV-positive partners in serodiscordant couples ranged from 45.4% in Ndhiwa to 70.7% in Gutu. Viral load suppression (VLS) ranged from 33.9% in Ndhiwa to 68.5% in Nsanje. VLS was similar by sex in three settings, Ndhiwa (37.8% (men) v. 27.8% (women); p=0.16), Nsanje (60.7% v. 76.9%; p=0.21) and Gutu (48.2% v. 55.6%; p=0.63), and dissimilar by sex in Chiradzulu (44.4% v. 62.7%; p=0.03).

CONCLUSIONS

Low HIV status awareness and poor VLS among HIV-positive partners are major gaps in preventing transmission among serodiscordant couples. Intensifying programmes that target couples to test for HIV and timely antiretroviral therapy initiation could increase VLS and reduce HIV transmission.

摘要

背景

HIV 血清不一致的夫妇感染 HIV 的风险很高。在撒哈拉以南非洲，HIV 血清不一致的夫妇约占该地区所有新感染的 30%。

目的

在撒哈拉以南非洲四个高流行地区，对 HIV 血清不一致的关系中 HIV 血清不一致的夫妇进行 HIV 护理连续体的步骤进行量化，并评估 HIV 血清不一致的夫妇中 HIV 血清不一致的流行率。

方法

进行了四项 HIV 流行率调查：2012 年在肯尼亚的恩迪瓦，2013 年在马拉维的奇拉祖鲁，以及 2016 年在津巴布韦的古图和马拉维的南泽。邀请 15-59 岁的合格个人参加自愿快速 HIV 检测。对那些 HIV 检测呈阳性的人进行病毒载量和 CD4 计数检测。如果一对夫妇报告说已婚或同居，并共同居住在同一个家庭中，则将其定义为夫妇。

结果

在 4385 对夫妇中，总体 HIV 血清不一致的流行率为 10.9%（95%置信区间 10.2-11.5），范围从南泽的 6.7%（95%置信区间 5.6-7.9）到恩迪瓦的 15.8%（95%置信区间 14.5-17.3）。在恩迪瓦的血清不一致的夫妇中，62.7%的男性是 HIV 阳性伴侣，在古图为 60.4%，在奇拉祖鲁为 48.8%，在南泽为 50.9%。血清不一致的夫妇中 HIV 阳性伴侣的知晓率从恩迪瓦的 45.4%到古图的 70.7%不等。病毒载量抑制（VLS）范围从恩迪瓦的 33.9%到南泽的 68.5%。在三个地方，VLS 的性别差异相似，恩迪瓦（37.8%（男性）与 27.8%（女性）；p=0.16），南泽（60.7%与 76.9%；p=0.21）和古图（48.2%与 55.6%；p=0.63），而在奇拉祖鲁的性别差异不同（44.4%与 62.7%；p=0.03）。