Clinical Epidemiology Unit, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda.
BMC Health Serv Res. 2024 Mar 8;24(1):319. doi: 10.1186/s12913-024-10770-1.
BACKGROUND: HIV mostly affects people with severe mental illnesses (SMIs) than the general population. In 2015, the World Health Organization (WHO) introduced assisted partner notification (APN) as a strategy to increase HIV testing. Although research has demonstrated the effectiveness of APN in the general population, its use among people living with HIV (PLHIV) who have SMI is not well understood. This study sought to determine the acceptance of the APN strategy among PLHIV who had a diagnosis of SMI. METHODS: This study used a cross-sectional study design that was retrospective to determine acceptance of APN among PLHIV with a documented diagnosis of SMI. We enrolled participants with a diagnosis of both HIV and SMI from August 2018 to January 2022, attending the HIV clinic at Butabika Hospital. We used pretested questionnaires to extract participants' demographic and clinical data from their existing clinical charts, antiretroviral therapy (ART) registers and APN registers. We defined acceptance of APN as the number of PLHIV with SMI diagnoses who agreed to provide information about their sexual partners. We used modified Poisson regression analysis to assess the factors associated with the acceptance of APN. RESULTS: A total of 125 participants were enrolled, of whom 83 (66.4%) were female. The median age was 30 (interquartile range (IQR) (25-34)), and 41 (33%) of them accepted APN (95% CI: 25.05-41.61). Receipt of at least three counselling sessions before enrollment in APN (aPR = 1.8, 95% CI: 1.72-1.98) was the most significant factor associated with increased acceptance of APN. Poor adherence to ART (aPR = 0.62, 95% CI: 0.54-0.80), being escorted to hospital by a distant relative (aPR = 0.55, 95% CI: 0.39-0.80), being married/cohabiting (aPR = 0.65, 95% CI: 0.60-0.81), and being a Seventh Day Adventist (SDA) (aPR = 0.53, 95% CI: 0.45-0.71) or Pentecostal (aPR = 0.44, 95% CI: 0.22-0.98) by faith were associated with reduced acceptance of APN. CONCLUSION AND RECOMMENDATION: The acceptance of APN is low among PLHIV with a diagnosis of SMI. More structured counselling would facilitate earlier identification of undiagnosed HIV-positive partners. We recommend a follow-up study to compare acceptance of APN among PLHIV with SMI and those without SMI.
背景：艾滋病毒主要影响患有严重精神疾病（SMI）的人群，而非普通人群。2015 年，世界卫生组织（WHO）引入辅助性伴侣通知（APN）作为增加艾滋病毒检测的策略。尽管研究表明 APN 在普通人群中的有效性，但对于患有 SMI 的艾滋病毒感染者（PLHIV）使用 APN 的情况了解甚少。本研究旨在确定患有 SMI 的 PLHIV 对 APN 策略的接受程度。
方法：本研究采用回顾性的横断面研究设计，以确定患有 SMI 的 PLHIV 对 APN 的接受程度。我们招募了 2018 年 8 月至 2022 年 1 月期间在布塔比卡医院 HIV 诊所就诊的既有 HIV 又有 SMI 诊断的参与者。我们使用预测试问卷从参与者现有的临床图表、抗逆转录病毒治疗（ART）登记册和 APN 登记册中提取参与者的人口统计学和临床数据。我们将 APN 的接受程度定义为同意提供其性伴侣信息的患有 SMI 诊断的 PLHIV 的数量。我们使用修正泊松回归分析评估与 APN 接受程度相关的因素。
结果：共纳入 125 名参与者，其中 83 名（66.4%）为女性。中位年龄为 30 岁（四分位距（IQR）（25-34）），其中 41 名（33%）接受了 APN（95%CI：25.05-41.61）。在参加 APN 之前接受至少三次咨询（调整后比值比（aPR）=1.8，95%CI：1.72-1.98）是与 APN 接受程度增加最显著相关的因素。ART 治疗依从性差（aPR=0.62，95%CI：0.54-0.80）、由远亲护送就医（aPR=0.55，95%CI：0.39-0.80）、已婚/同居（aPR=0.65，95%CI：0.60-0.81）、是第七日安息日会（SDA）（aPR=0.53，95%CI：0.45-0.71）或五旬节派（aPR=0.44，95%CI：0.22-0.98）信仰与 APN 接受程度降低相关。
结论和建议：患有 SMI 的 PLHIV 对 APN 的接受程度较低。更多的结构化咨询将有助于更早地发现未确诊的 HIV 阳性伴侣。我们建议进行后续研究，以比较患有 SMI 和无 SMI 的 PLHIV 对 APN 的接受程度。
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