McKenna S L, Muyinda G K, Roth D, Mwali M, Ng'andu N, Myrick A, Luo C, Priddy F H, Hall V M, von Lieven A A, Sabatino J R, Mark K, Allen S A
Project San Francisco, Lusaka, Zambia.
AIDS. 1997 Sep;11 Suppl 1:S103-10.
Voluntary HIV testing and counseling (VTC) has been shown to reduce the incidence of HIV in cohabiting couples who now represent the majority of new infections in many African cities. Community and client perceptions of a 1-day voluntary testing and counseling program in Lusaka, Zambia, were assessed, and a rapid HIV-testing algorithm was evaluated for VTC centers.
Between May 1995 and June 1996, outreach workers distributed written invitations door to door. The 1-day program was held 6 days/week including weekends. Transport, child care and lunch were provided. Community and client surveys followed in July 1996.
Over 3500 couples married for a median of 4-5 years requested testing: 23% were HIV+/+, 57% were HIV-/- and 20% were discordant with one HIV+ and one HIV- partner. Sixty-eight per cent of couples surveyed had made the decision to be tested before attending the 1-day program and 80% had not previously known where to obtain HIV testing. Knowledge that couples could show discordant results rose from 29 before to 88% after pretest counseling. Clients reported high levels of satisfaction with the services and 90 out of 99 (92%) preferred to receive their results the same day. Clients at another center who waited 10 days for their results reported more fear, and 19 out of 31 (61%) would have preferred to get their results the same day. Over 99% of those who attended the program thought active promotion of voluntary HIV testing in the community was a positive thing, as did 90% of those who were invited but did not attend. Sensitivity and specificity of the rapid test algorithm were both 99.4% in this setting.
Active promotion of voluntary HIV testing and counseling in couples is needed to reduce the spread of HIV in high-prevalence areas. The use of rapid, on-site HIV testing allows clients to receive result-specific counseling in a single visit. Ongoing quality control of a subset of samples at an outside laboratory is essential.
自愿性艾滋病毒检测与咨询（VTC）已被证明可降低同居伴侣中艾滋病毒的感染率，而同居伴侣如今在许多非洲城市的新增感染病例中占多数。对赞比亚卢萨卡一项为期1天的自愿检测与咨询项目的社区及服务对象的看法进行了评估，并针对VTC中心对一种快速艾滋病毒检测算法进行了评价。
1995年5月至1996年6月期间，外展工作人员挨家挨户发放书面邀请函。该为期1天的项目每周6天开展，包括周末。提供交通、儿童照料和午餐。1996年7月进行了社区及服务对象调查。
超过3500对结婚年限中位数为4至5年的夫妻要求进行检测：23%为双方均感染艾滋病毒（HIV+/+），57%为双方均未感染艾滋病毒（HIV-/-），20%为一方感染艾滋病毒而另一方未感染艾滋病毒的不一致情况。接受调查的夫妻中有68%在参加为期1天的项目之前就已决定进行检测，80%此前不知道在哪里可以进行艾滋病毒检测。了解夫妻可能出现不一致检测结果的比例从检测前咨询时的29%升至检测后咨询时的88%。服务对象对服务的满意度较高，99名服务对象中有90名（92%）希望在同一天得到检测结果。在另一个中心等待10天获取检测结果的服务对象表示更加恐惧，31名中有19名（61%）希望在同一天得到结果。参加该项目的人中有超过99%认为在社区积极推广自愿性艾滋病毒检测是一件好事，受邀但未参加的人中有90%也持同样看法。在这种情况下，快速检测算法的灵敏度和特异度均为99.4%。
需要在夫妻中积极推广自愿性艾滋病毒检测与咨询，以减少艾滋病毒在高流行地区的传播。使用快速的现场艾滋病毒检测可让服务对象在一次就诊中接受针对检测结果的咨询。在外部实验室对一部分样本持续进行质量控制至关重要。
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