南非农村地区中老年人群基于家庭的 HIV 检测策略。

Home-based HIV testing strategies for middle-aged and older adults in rural South Africa.

机构信息

Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

AIDS. 2023 Nov 15;37(14):2213-2221. doi: 10.1097/QAD.0000000000003698. Epub 2023 Sep 5.

DOI:10.1097/QAD.0000000000003698

PMID:37696252

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10615729/

Abstract

OBJECTIVE

More than one in four adults over 40 years with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing strategies for middle-aged and older adults in rural South Africa.

DESIGN

Two thousand nine hundred and sixty-three individuals in the 'Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)' cohort study were randomized 1 : 1 : 1 to one of three types of home-based and home-delivered HIV testing modalities: rapid testing with counseling; self-testing, and both rapid testing with counselling and self-testing.

METHOD

In OLS regression analyses, we estimated the treatment effects on HIV testing and HIV testing frequency at about 1 year after delivery. Finally, we assessed the potential adverse effects of these strategies on the secondary outcomes of depressive symptom as assessed by the CESD-20, linkage to care, and risky sexual behavior.

RESULTS

There were no significant differences in HIV testing uptake or testing frequency across groups. However, respondents in the self-testing treatment arms were more likely to shift from testing at home and a facility [self-testing (HIVST), -8 percentage points (pp); 95% confidence interval (CI) -14 to -2 pp; self-testing plus rapid testing and counselling (ST+RT+C); -9 pp, 95% CI -15 to -3 pp] to testing only at home (HIVST 5 pp; 95% CI 2 to 9 pp; ST+RT+C: 5 pp, 95% CI 1 to 9 pp) - suggesting a revealed preference for self-testing in this population. We also found no adverse effects of this strategy on linkage to care for HIV and common comorbidities, recent sexual partners, or condom use. Finally, those in the self-testing only arm had significantly decreased depressive symptom scores by 0.58 points (95% CI -1.16 to -0.01).

CONCLUSION

We find HIV self-testing to be a well tolerated and seemingly preferred home-based testing option for middle-aged and older adults in rural South Africa. This approach should be expanded to achieve the UNAIDS 95-95-95 targets.

摘要

目的

南非 40 岁以上的成年人中，超过四分之一的人不知道自己的 HIV 状况，也没有接受抗逆转录病毒治疗 (ART)。HIV 自我检测可能是为老年成年人填补这一空白的有力手段。在这里，我们报告了一项针对南非农村地区中年和老年成年人的三种不同家庭 HIV 检测策略的随机比较有效性试验的结果。

设计

在“非洲健康与衰老：南非一个 INDEPTH 社区的纵向研究 (HAALSI)”队列研究中，2963 人被随机 1:1:1 分配到三种家庭提供和家庭交付的 HIV 检测方式之一：快速检测加咨询；自我检测，以及快速检测加咨询和自我检测。

方法

在 OLS 回归分析中，我们估计了在交付后约 1 年时对 HIV 检测和 HIV 检测频率的治疗效果。最后，我们评估了这些策略对次要结果的潜在不利影响，包括使用 CESD-20 评估的抑郁症状、与护理的联系以及危险性行为。

结果

各组在 HIV 检测率或检测频率方面没有显著差异。然而，自我检测治疗组的受访者更有可能从家庭和医疗机构检测转变为仅在家中检测[自我检测 (HIVST)，-8 个百分点 (pp)；95%置信区间 (CI) -14 至-2 pp；自我检测加快速检测和咨询 (ST+RT+C)，-9 pp，95% CI -15 至-3 pp] - 表明在该人群中对自我检测有明显的偏好。我们还没有发现这种策略对 HIV 和常见合并症、最近的性伴侣或避孕套使用的护理联系产生不利影响。最后，仅进行自我检测的那组抑郁症状评分显著降低了 0.58 分（95% CI -1.16 至-0.01）。