DiFranceisco W, Holtgrave D R, Hoxie N, Reiser W J, Resenhoeft R, Pinkerton S D, Vergeront J
Cost-Effectiveness Studies Core, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee 53226, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Nov 1;19(3):282-8. doi: 10.1097/00042560-199811010-00011.
A common assumption is that outreach-based HIV counseling and testing services reach a clientele with a higher HIV seroprevalence than clinic-based counseling and testing. To examine this assumption, we analyzed Wisconsin's anonymous counseling and testing client records for 62,299 contacts (testing episodes) from 1992 to 1995. Bivariate analysis of counseling and testing service setting (outreach-based or clinic-based) and HIV test results suggested that outreach contacts were 23% (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.0-1.5) more likely to test HIV-seropositive than clinic-based contacts. Relations between HIV test outcome and variables for client age, race, gender, previous testing history, mode of risk exposure, and region, as well as service setting, were examined by logistic regression. An inverted relation between service setting and seropositivity (OR, 0.65; 95% CI, 0.5-0.8) indicated that, within some subpopulations, outreach contacts were significantly less likely to test HIV-positive than clinic-based contacts. Analysis of interactions among the covariates identified race as a critical codeterminant in the relation between service setting and test outcome. These results support retargeting outreach services to enhance their overall effectiveness. Specific recommendations include the need for aggressive strategies to better "market" HIV counseling and testing to nonwhite populations, and to focus resources more selectively on gay/bisexual men of all races.
一个普遍的假设是，与基于诊所的咨询和检测相比，基于外展服务的艾滋病毒咨询和检测服务所接触的人群艾滋病毒血清阳性率更高。为了检验这一假设，我们分析了威斯康星州1992年至1995年62299次接触（检测事件）的匿名咨询和检测客户记录。对咨询和检测服务地点（基于外展服务或基于诊所）与艾滋病毒检测结果进行的双变量分析表明，与基于诊所的接触者相比，接受外展服务的接触者艾滋病毒检测呈阳性的可能性高23%（优势比[OR]，1.23；95%置信区间[95%CI]，1.0 - 1.5）。通过逻辑回归分析了艾滋病毒检测结果与客户年龄、种族、性别、既往检测史、风险暴露方式、地区以及服务地点等变量之间的关系。服务地点与血清阳性率之间的反向关系（OR，0.65；95%CI，0.5 - 0.8）表明，在一些亚人群中，接受外展服务的接触者艾滋病毒检测呈阳性的可能性明显低于基于诊所的接触者。对协变量之间相互作用的分析确定种族是服务地点与检测结果之间关系的关键共同决定因素。这些结果支持重新调整外展服务的目标，以提高其整体效果。具体建议包括需要采取积极策略，更好地向非白人人群“推销”艾滋病毒咨询和检测，并更有针对性地将资源集中于所有种族的男同性恋者/双性恋男性。
