Rwanda Biomedical Centre, Kigali, Rwanda; University of Basel, Basel, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland.
Rwanda Biomedical centre, Kigali, Rwanda.
Lancet HIV. 2022 Mar;9 Suppl 1:S6. doi: 10.1016/S2352-3018(22)00071-6.
As Rwanda inches closer to the UNAIDS HIV first 95 of knowing one's HIV status by 2030, finding the remaining HIV-positive individuals could be difficult by use of passive methods. Index testing is an approach whereby the exposed contacts of an HIV-positive person are notified and offered an HIV test. We aimed to assess the factors related to the HIV-positive outcome among older people (aged 50 years and above) in Rwanda.
In Rwanda, adults (aged ≥18 years) on antiretroviral therapy (ART) who reported having had sexual partners with unknown HIV status, and individuals with newly diagnosed HIV, described as index cases, were asked to provide details of their sexual partners and invite them to the health facility for HIV testing through client referral, provider referral, or dual referral. We used logistic regression to model the odds of identifying partners who were HIV-positive or aged 50 years or older through partner notification services and to assess predictive factors related to index case and partner, after adjusting for partner related variables (age group, gender, relationship between index and sexual partner, province of residence, notification used) and index case related variables (type of index case, multiple partnership, had unprotected sex in past 12 months, viral load suppression, age difference between notified sexual partner and index case). Written informed consent was obtained from each participant before inclusion in the study. The Rwanda National Ethics Committee approved the protocol for implementation.
Between October, 2018, and September, 2021, 18 453 index cases were recruited and 31 227 partners were notified and tested, of whom 3156 (10·0%) were aged 50 years and older. Of the partners aged 50 years and older, 877 (27·8%) were female and 2279 (88·1%) were male, and 1638 (51·9%) were notified by index cases who were younger than them. Among partners aged 50 years and older, 6·0% (3156) were HIV-positive, with a higher prevalence in partners notified by newly diagnosed index cases 14·7% (46 of 313). In the multivariable analysis, among partners aged 50 years and older, the adjusted odds ratio was 2·66 (95% CI 1·78-3·98) for female partners compared with male partners, 3·14 (2·08-4·77) for partners of newly HIV-diagnosed index cases compared with those of index cases who were already taking ART, and 1·89 (1·07-3·37) for partners who were 15 years older than the index case compared with partners who were 5 years older or younger.
Partners of people with newly diagnosed HIV, older individuals who engaged in sexual relationship with younger individuals, and female partners had an increased risk of being diagnosed with HIV. Index testing successfully identified older people with undiagnosed HIV.
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随着卢旺达逐渐接近联合国艾滋病规划署 2030 年实现 95%的艾滋病毒感染者知晓自身艾滋病毒感染状况的目标，通过被动方法发现其余艾滋病毒阳性个体可能会变得困难。指数检测是一种方法，通过该方法，艾滋病毒阳性者的接触者会被通知并接受艾滋病毒检测。我们旨在评估与卢旺达 50 岁及以上老年人艾滋病毒阳性结果相关的因素。
在卢旺达，正在接受抗逆转录病毒治疗（ART）的成年人（年龄≥18 岁）报告称有性伴侣且其艾滋病毒感染状况未知，以及新诊断出艾滋病毒的个体（称为索引病例），被要求提供其性伴侣的详细信息，并通过患者转介、医务人员转介或双重转介邀请他们到医疗机构进行艾滋病毒检测。我们使用逻辑回归模型来模拟通过伙伴通知服务识别艾滋病毒阳性或 50 岁及以上伙伴的可能性，并在调整伙伴相关变量（年龄组、性别、索引和性伴侣之间的关系、居住省份、使用的通知方法）和索引病例相关变量（索引病例类型、多重性伴侣、过去 12 个月有无无保护性行为、病毒载量抑制、通知的性伴侣与索引病例之间的年龄差异）后，评估与索引病例和伙伴相关的预测因素。在将每个参与者纳入研究之前，均获得了他们的书面知情同意。卢旺达国家伦理委员会批准了实施该方案。
2018 年 10 月至 2021 年 9 月，共招募了 18453 名索引病例，并通知了 31227 名伙伴进行检测，其中 3156 名（10.0%）年龄在 50 岁及以上。在 50 岁及以上的伙伴中，877 名（27.8%）为女性，2279 名（88.1%）为男性，其中 1638 名（51.9%）是由年龄小于他们的索引病例通知的。在 50 岁及以上的伙伴中，有 6.0%（3156 人）为艾滋病毒阳性，新诊断的索引病例通知的伙伴中艾滋病毒阳性率更高，为 14.7%（46 人）。在多变量分析中，与男性相比，50 岁及以上的女性伙伴的调整后比值比为 2.66（95%CI 1.78-3.98），与已经接受 ART 的索引病例相比，新诊断为 HIV 的索引病例的伙伴的调整后比值比为 3.14（2.08-4.77），与年龄比索引病例小 15 岁的伙伴相比，年龄为 5 岁或更小的伙伴的调整后比值比为 1.89（1.07-3.37）。
新诊断出艾滋病毒的个体的性伴侣、与年轻个体发生性关系的年长个体以及女性伴侣，感染艾滋病毒的风险增加。指数检测成功地发现了未确诊的艾滋病毒感染的老年人。
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