在城市人群中推广 HIV 指数检测：肯尼亚内罗毕县的经验与成就。

Scale-up of HIV index testing in an urban population: Experiences and achievements from Nairobi County, Kenya.

机构信息

Center for International Health, Education, and Biosecurity, Maryland Global Initiatives Corporation, Nairobi, Kenya.

Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.

出版信息

Trop Med Int Health. 2023 Feb;28(2):116-125. doi: 10.1111/tmi.13843. Epub 2023 Jan 13.

DOI:10.1111/tmi.13843

PMID:36538038

Abstract

OBJECTIVE

To describe the implementation strategies of the index testing program across Nairobi County in Kenya, assess outcomes along the HIV index testing cascade (acceptance, elicitation ratio, HIV positivity and linkage to treatment), and assess annual changes along the HIV index testing cascade during the first 2 years of implementation.

METHODS

Retrospective analysis of programmatic aggregate data collected from October 2017 to September 2019 after the roll-out of index testing services in 48 health facilities in Nairobi County. Proportions and ratios were calculated for acceptance, elicitation ratio, testing uptake and HIV positivity. We compared these outcomes between years using a chi-squared test, Fisher's exact test or Wilcoxon sign test, and we assessed trends using the Mann-Kendall test.

RESULTS

Testing among eligible partners increased from 42.4% (1471/3470) to 74.9% (6114/8159) in the general population, and the positivity yield remained high across both years (25.2% in year 1 and 24.1% in year 2). Index testing positivity yield remained significantly higher than other testing modalities (24.3% vs. 1.3%, p < 0.001). The contribution of index testing services to the total number of HIV-positive individuals identified increased from 7.5% in the first year to 28.6% in the second year (p < 0.001). More men were tested, but the positivity yield was higher among women (30.0%) and those aged 50 years or older (32.4%). Testing eligible partners in key populations (KPs) decreased from 52.4% (183/349) to 40.7% (109/268) (p = 0.674); however, the HIV positivity yield increased from 8.6% to 23.9% (p < 0.001) by the second year of implementation. The HIV positivity yield from index testing remained higher than other testing modalities (14% vs. 0.9%, p < 0.001) for KPs.

CONCLUSION

Index testing was well-accepted and effective in identifying individuals living with HIV in a Kenyan urban setting across both general populations and KPs. Ongoing adaptations to the strategies deployed as part of index testing services helped improve most of the outcomes along the index testing cascade.

摘要

目的

描述肯尼亚内罗毕县开展指数检测项目的实施策略，评估 HIV 指数检测级联（接受、引出比、HIV 阳性率和治疗关联）的结果，并评估实施后的头 2 年中 HIV 指数检测级联的年度变化。

方法

对 2017 年 10 月至 2019 年 9 月在 48 家卫生机构推出指数检测服务后的方案汇总数据进行回顾性分析。采用卡方检验、Fisher 确切检验或 Wilcoxon 符号检验比较两年间的接受率、引出比、检测率和 HIV 阳性率，采用 Mann-Kendall 检验评估趋势。

结果

在一般人群中，符合条件的伴侣接受检测的比例从 42.4%（1471/3470）增加到 74.9%（6114/8159），阳性检出率在两年内均保持较高水平（第 1 年为 25.2%，第 2 年为 24.1%）。与其他检测方法相比，指数检测的阳性检出率仍然显著更高（24.3% vs. 1.3%，p<0.001）。指数检测服务对总 HIV 阳性人数的贡献从第 1 年的 7.5%增加到第 2 年的 28.6%（p<0.001）。更多男性接受了检测，但女性（30.0%）和 50 岁及以上人群（32.4%）的阳性检出率更高。关键人群（KP）中符合条件的伴侣检测率从 52.4%（183/349）下降到 40.7%（109/268）（p=0.674）；然而，第二年的阳性检出率从 8.6%增加到 23.9%（p<0.001）。KP 中，与其他检测方法相比，指数检测的阳性检出率仍较高（14% vs. 0.9%，p<0.001）。