Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda.
Infectious Diseases Research Collaboration, Kampala, Uganda.
AIDS Care. 2024 Apr;36(4):482-490. doi: 10.1080/09540121.2023.2223901. Epub 2023 Jun 18.
Targeted strategies are central to increasing HIV-status awareness and progress on the care cascade among men. We implemented Village-Health-Team (VHT)-delivered HIV self-testing (HIVST) among men in a peri-urban Ugandan district and assessed linkage to confirmatory-testing, antiretroviral-therapy (ART) initiation and HIV-status disclosure following HIVST. We conducted a prospective cohort study from November 2018 to June 2019 and enrolled 1628 men from 30-villages of Mpigi district. VHTs offered each participant one HIVST-kit and a linkage-to-care information leaflet. At baseline, we collected data on demographics, testing history and risk behavior. At one-month, we measured linkage to confirmatory-testing and HIV-status disclosure, and at three months ART-initiation if tested HIV-positive. We used Poisson regression generalized estimating equations to evaluate predictors of confirmatory-testing. We found that 19.8% had never tested for HIV and 43% had not tested in the last 12-months. After receiving HIVST-kits, 98.5% self-reported HIVST-uptake in 10-days, 78.8% obtained facility-based confirmation in 30-days of HIVST with 3.9% tested HIV-positive. Of the positives, 78.8% were newly diagnosed, 88% initiated ART and 57% disclosed their HIV-status to significant others. Confirmatory testing was associated with having a higher level of education and knowing a partner's HIV-status. VHT-delivered HIVST may be effective for boosting testing, ART-initiation and HIV-status disclosure among men.
目标策略是提高 HIV 感染者知晓率和艾滋病护理服务衔接率的核心。我们在乌干达郊区实施了乡村卫生工作队(VHT)提供的 HIV 自我检测(HIVST),并评估了 HIVST 后与确认检测、抗逆转录病毒治疗(ART)启动和 HIV 状态披露的衔接情况。我们开展了一项前瞻性队列研究,时间为 2018 年 11 月至 2019 年 6 月,纳入了 Mpigi 区 30 个村庄的 1628 名男性。VHT 为每位参与者提供了一份 HIVST 试剂盒和一份衔接至护理的信息传单。在基线时,我们收集了人口统计学、检测史和风险行为的数据。在一个月时,我们测量了与确认检测和 HIV 状态披露的衔接情况,如果检测 HIV 阳性,则在三个月时测量 ART 启动情况。我们使用泊松回归广义估计方程来评估确认检测的预测因素。我们发现,19.8%的人从未接受过 HIV 检测,43%的人在过去 12 个月内未接受过检测。在收到 HIVST 试剂盒后,98.5%的人在 10 天内报告了 HIVST 检测,78.8%的人在 30 天内获得了基于机构的确认检测,其中 3.9%的人 HIV 检测呈阳性。在阳性者中,78.8%为新诊断病例,88%开始接受 ART 治疗,57%向重要他人披露了 HIV 状态。确认检测与受教育程度较高和知晓伴侣 HIV 状态有关。VHT 提供的 HIVST 可能对提高男性的检测率、ART 启动率和 HIV 状态披露率有效。
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