Department of Global Health and Population, Harvard University, Cambridge, Massachusetts, USA.
Global HIV, Hepatitis and STIs Programs, World Health Organization, Geneva, Switzerland.
J Int AIDS Soc. 2024 Apr;27(4):e26229. doi: 10.1002/jia2.26229.
INTRODUCTION: Following HIV testing services (HTS), the World Health Organization recommends prompt linkage to prevention and treatment. Scale-up of effective linkage strategies is essential to achieving the global 95-95-95 goals for maintaining low HIV incidence by 2030 and reducing HIV-related morbidity and mortality. Whereas linkage to care including same-day antiretroviral therapy (ART) initiation for all people with HIV is now routinely implemented in testing programmes, linkage to HIV prevention interventions including behavioural or biomedical strategies, for HIV-negative individuals remains sub-optimal. This review aims to evaluate effective post-HTS linkage strategies for HIV overall, and highlight gaps specifically in linkage to prevention. METHODS: Using the five-step Arksey and O'Malley framework, we conducted a scoping review searching existing published and grey literature. We searched PubMed, Cochrane Library, CINAHL, Web of Science and EMBASE databases for English-language studies published between 1 January 2010 and 30 November 2023. Linkage interventions included as streamlined interventions-involving same-day HIV testing, ART initiation and point-of-care CD4 cell count/viral load, case management-involving linkage coordinators developing personalized HIV care and risk reduction plans, incentives-financial and non-financial, partner services-including contact tracing, virtual-like social media, quality improvement-like use of score cards, and peer-based interventions. Outcomes of interest were linkage to any form of HIV prevention and/or care including ART initiation. RESULTS: Of 2358 articles screened, 66 research studies met the inclusion criteria. Only nine linkage to prevention studies were identified (n = 9/66, 14%)-involving pre-exposure prophylaxis, voluntary medical male circumcision, sexually transmitted infection and cervical cancer screening. Linkage to care studies (n = 57/66, 86%) focused on streamlined interventions in the general population and on case management among key populations. DISCUSSION: Despite a wide range of HIV prevention interventions available, there was a dearth of literature on HIV prevention programmes and on the use of messaging on treatment as prevention strategy. Linkage to care studies were comparatively numerous except those evaluating virtual interventions, incentives and quality improvement. CONCLUSIONS: The findings give insights into linkage strategies but more understanding of how to provide these effectively for maximum prevention impact is needed.
简介:在进行艾滋病毒检测服务(HTS)后,世界卫生组织建议及时将患者与预防和治疗措施联系起来。扩大有效的联系策略对于实现全球 95-95-95 目标至关重要,该目标旨在到 2030 年维持低艾滋病毒发病率,并减少与艾滋病毒相关的发病率和死亡率。目前,所有艾滋病毒感染者都可以在检测计划中接受包括当天开始抗逆转录病毒治疗(ART)在内的护理服务,但艾滋病毒阴性个体与艾滋病毒预防干预措施(包括行为或生物医学策略)的联系仍然不理想。本综述旨在评估总体艾滋病毒检测后联系策略的有效性,并特别强调预防联系方面的差距。
方法:我们使用五步阿特金森和奥马利框架,对现有已发表和灰色文献进行了范围综述。我们在 PubMed、Cochrane 图书馆、CINAHL、Web of Science 和 EMBASE 数据库中检索了 2010 年 1 月 1 日至 2023 年 11 月 30 日期间发表的英语研究。联系干预措施包括简化干预措施,即当天进行艾滋病毒检测、开始抗逆转录病毒治疗和即时 CD4 细胞计数/病毒载量、病例管理,即联系协调员制定个性化的艾滋病毒护理和减少风险计划、激励措施,包括财务和非财务激励措施、伙伴服务,包括接触者追踪、虚拟社交媒体、使用记分卡等质量改进措施以及基于同伴的干预措施。感兴趣的结果是与任何形式的艾滋病毒预防和/或护理措施联系起来,包括开始抗逆转录病毒治疗。
结果:在筛选的 2358 篇文章中,有 66 项研究符合纳入标准。仅确定了 9 项预防联系研究(n=9/66,14%),涉及暴露前预防、自愿医疗男性包皮环切术、性传播感染和宫颈癌筛查。护理联系研究(n=57/66,86%)主要集中在一般人群中的简化干预措施和重点人群中的病例管理。
讨论:尽管有广泛的艾滋病毒预防干预措施,但关于艾滋病毒预防方案以及将治疗作为预防策略的信息传递的文献却很少。与护理联系的研究相对较多,但评估虚拟干预、激励措施和质量改进的研究较少。
结论:这些发现为联系策略提供了一些见解,但需要进一步了解如何有效地提供这些策略,以实现最大的预防效果。
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