PART Fellowship, Makerere University, Kampala, Uganda.
Department of Social Science Research Institute, Duke University, Durham, USA.
BMC Infect Dis. 2023 Jun 9;23(1):388. doi: 10.1186/s12879-023-08365-y.
Strong epidemiological links between human immunodeficiency virus (HIV) and tuberculosis (TB) may make household TB contact investigation an efficient strategy for HIV screening and finding individuals in serodifferent partnerships at risk of HIV and linking them to HIV prevention services. We aimed to compare the proportions of HIV serodifferent couples in TB-affected households and in the general population of Kampala, Uganda.
We included data from a cross-sectional trial of HIV counselling and testing (HCT) in the context of home-based TB evaluation in Kampala, Uganda in 2016-2017. After obtaining consent, community health workers visited the homes of participants with TB to screen contacts for TB and offer HCT to household members ≥ 15 years. We defined index participants and their spouses or parents as couples. Couples were classified as serodifferent if confirmed by self-reported HIV status or by HIV testing results. We used a two-sample test of proportions to compare the frequency of HIV serodifference among couples in the study to its prevalence among couples in Kampala in the 2011 Uganda AIDS Indicator Survey (UAIS).
We included 323 index TB participants and 507 household contacts aged ≥ 18 years. Most index participants (55%) were male, while most (68%) adult contacts were female. There was ≥ 1 couple in 115/323 (35.6%) households, with most couples (98/115, 85.2%) including the index participant and spouse. The proportion of households with HIV-serodifferent couples was 18/323 (5.6%), giving a number-needed-to-screen of 18 households. The proportion of HIV serodifference among couples identified in the trial was significantly higher than among couples in the UAIS (15.7% vs. 8%, p = 0.039). The 18 serodifferent couples included 14 (77.8%) where the index participant was living with HIV and the spouse was HIV-negative, and 4 (22.2%) where the index partner was HIV-negative, while the spouse was living with HIV.
The frequency of HIV serodifference among couples identified in TB-affected households was higher than in the general population. TB household contact investigation may be an efficient strategy for identifying people with substantial exposure to HIV and linking them to HIV prevention services.
人类免疫缺陷病毒（HIV）和结核病（TB）之间存在强烈的流行病学联系，这使得对家庭内 TB 接触者进行调查可能成为 HIV 筛查的有效策略，有助于发现处于不同性伴关系且有 HIV 感染风险的个体，并将他们与 HIV 预防服务联系起来。我们旨在比较乌干达坎帕拉受 TB 影响家庭和一般人群中 HIV 血清学不同的夫妇比例。
我们纳入了 2016 年至 2017 年在乌干达坎帕拉进行的家庭为基础的 TB 评估背景下的 HIV 咨询和检测（HCT）的一项横断面试验的数据。在获得同意后，社区卫生工作者会前往参与者家中筛查 TB 接触者，并为 ≥ 15 岁的家庭成员提供 HCT。我们将确诊 TB 的参与者及其配偶或父母定义为夫妇。如果夫妇通过自我报告的 HIV 状况或 HIV 检测结果证实为 HIV 血清学不同，则将其分类为血清学不同。我们使用两样本比例检验来比较研究中夫妇的 HIV 血清学不同频率与其在 2011 年乌干达艾滋病指标调查（UAIS）中在坎帕拉的流行率。
我们纳入了 323 名确诊 TB 的参与者和 507 名年龄为 ≥ 18 岁的家庭接触者。大多数指数参与者（55%）为男性，而大多数（68%）成年接触者为女性。在 323 个家庭中，有 ≥ 1 对夫妇，占 115/323（35.6%），大多数夫妇（98/115，85.2%）包括指数参与者及其配偶。有 HIV 血清学不同夫妇的家庭比例为 18/323（5.6%），需要筛查的家庭数量为 18 户。试验中确定的 HIV 血清学不同夫妇的比例明显高于 UAIS（15.7%对 8%，p=0.039）。18 对血清学不同的夫妇中，有 14 对（77.8%）的情况是指数参与者携带 HIV，而配偶 HIV 阴性，4 对（22.2%）的情况是指数伴侣 HIV 阴性，而配偶携带 HIV。
在受 TB 影响的家庭中确定的 HIV 血清学不同夫妇的频率高于一般人群。对家庭内 TB 接触者进行调查可能是一种有效的策略，可以发现大量接触 HIV 的人群，并将他们与 HIV 预防服务联系起来。
