HJF Medical Research International, Kisumu, Kenya.
United States Army Medical Research Directorate-Africa, Nairobi, Kenya.
PLoS One. 2024 Jan 2;19(1):e0294860. doi: 10.1371/journal.pone.0294860. eCollection 2024.
Despite declines in new HIV diagnoses both globally and in Kenya, parts of Western Kenya still report high HIV prevalence and incidence. We evaluated HIV prevalence to inform the development of policies for strategic and targeted HIV prevention interventions.
Adult participants aged 18-35 years were recruited in Kisumu County and screened for HIV for a prospective HIV incidence cohort. Questionnaires assessed HIV-associated risk behaviors. Participants who tested positive for HIV were disaggregated into groups based on prior knowledge of their HIV status: previously-diagnosed and newly-diagnosed. In separate analyses by prior knowledge, robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with a positive HIV test in each group, as compared to participants without HIV.
Of 1059 participants tested for HIV, 196 (18.5%) had a positive HIV test. Among PLWH, 78 (39.8%) were newly diagnosed with HIV at screening. After adjusting for other variables, previously-diagnosed HIV was more common among females than males (PR 2.70, 95%CI 1.69-4.28), but there was no observed sex difference in newly-diagnosed HIV prevalence (PR 1.05, 95%CI 0.65-1.69). Previously-diagnosed HIV was also more common among people reporting consistent use of condoms with primary sexual partners as compared to inconsistent condom use (PR 3.19, 95%CI 2.09-4.86), but newly-diagnosed HIV was not associated with such a difference between consistent and inconsistent condom use (PR 0.73, 95%CI 0.25-2.10).
Prevalence of newly-diagnosed HIV was high, at approximately 8% of participants, and not statistically different between genders, highlighting the need for improved HIV case finding regardless of sex. The higher prevalence of previously-diagnosed HIV in female participants may reflect higher rates of HIV testing through more encounters with the healthcare system. Higher prevalence of consistent condom use amongst those previously-diagnosed suggests behavioral change to reduce HIV transmission, a potential benefit of policies to facilitate earlier HIV diagnosis.
尽管全球和肯尼亚的新艾滋病诊断病例均有所下降，但肯尼亚西部的一些地区仍报告艾滋病发病率较高。我们评估了艾滋病的流行率，以制定针对艾滋病预防干预措施的战略和有针对性的政策。
在基苏木县招募了 18-35 岁的成年参与者，并对他们进行了艾滋病毒筛查，以建立一个前瞻性艾滋病毒发病率队列。调查问卷评估了与艾滋病毒相关的风险行为。对艾滋病毒检测呈阳性的参与者根据其艾滋病毒状况的先前知识进行分组：先前诊断和新诊断。在根据先前知识进行的单独分析中，使用稳健泊松回归估计了每个组中与阳性艾滋病毒检测相关的因素的患病率比（PR）和 95%置信区间（CI），与未感染艾滋病毒的参与者进行比较。
在接受艾滋病毒检测的 1059 名参与者中，有 196 名（18.5%）艾滋病毒检测呈阳性。在 PLWH 中，有 78 名（39.8%）在筛查时新诊断为 HIV。在调整其他变量后，与男性相比，女性中先前诊断的 HIV 更为常见（PR 2.70，95%CI 1.69-4.28），但新诊断的 HIV 患病率未观察到性别差异（PR 1.05，95%CI 0.65-1.69）。与不一致使用避孕套相比，与主要性伴侣持续使用避孕套的人先前诊断的 HIV 更为常见（PR 3.19，95%CI 2.09-4.86），但新诊断的 HIV 与这种一致和不一致使用避孕套之间没有差异（PR 0.73，95%CI 0.25-2.10）。
新诊断的 HIV 患病率较高，约为参与者的 8%，且在性别之间无统计学差异，这突出表明无论性别如何，都需要改进 HIV 病例发现。女性参与者中先前诊断的 HIV 患病率较高，可能反映出通过更多的医疗保健系统接触，HIV 检测率更高。在那些先前诊断的人中，更一致地使用避孕套的比例较高，这表明行为发生了变化，以减少艾滋病毒传播，这可能是促进早期艾滋病毒诊断的政策的一个潜在好处。
