Abstract：
HIV testing efficiency could be improved by focusing on high yield populations and identifying types of health facilities where people with undiagnosed HIV infection are more likely to attend.
A retrospective cohort analysis of data collected during an integrated TB/HIV active case-finding intervention in Western Kenya. Data were analyzed from health facilities\' registers on individuals who reported TB-suggestive symptoms between 1 July and 31 December 2018 and who had an HIV test result within one month following symptom screening. We used logistic regression with general estimating equations adjusting for sub-county level data to identify health facility-level predictors of new HIV diagnoses.
Of 11,376 adults with presumptive TB identified in 143 health facilities, 1038 (9%) tested HIV positive. The median HIV positivity per health facility was 6% (IQR = 2-15%). Patients with TB symptoms were over three times as likely to have a new HIV diagnosis in private not-for-profit facilities compared to those in government facilities (adjusted odds ratio (aOR) 3.40; 95% CI = 1.96-5.90). Patients tested in hospitals were over two times as likely to have a new HIV diagnosis as those tested in smaller facilities (i.e., health centers and dispensaries) (aOR 2.26; 95% CI = 1.60-3.21).
Individuals with presumptive TB who attended larger health facilities and private not-for-profit facilities had a higher likelihood of being newly diagnosed with HIV. Strengthening HIV services at these facilities and outreach to populations that use them could help to close the HIV diagnosis gap.
A retrospective cohort analysis of data collected during an integrated TB/HIV active case-finding intervention in Western Kenya. Data were analyzed from health facilities\' registers on individuals who reported TB-suggestive symptoms between 1 July and 31 December 2018 and who had an HIV test result within one month following symptom screening. We used logistic regression with general estimating equations adjusting for sub-county level data to identify health facility-level predictors of new HIV diagnoses.
Of 11,376 adults with presumptive TB identified in 143 health facilities, 1038 (9%) tested HIV positive. The median HIV positivity per health facility was 6% (IQR = 2-15%). Patients with TB symptoms were over three times as likely to have a new HIV diagnosis in private not-for-profit facilities compared to those in government facilities (adjusted odds ratio (aOR) 3.40; 95% CI = 1.96-5.90). Patients tested in hospitals were over two times as likely to have a new HIV diagnosis as those tested in smaller facilities (i.e., health centers and dispensaries) (aOR 2.26; 95% CI = 1.60-3.21).
Individuals with presumptive TB who attended larger health facilities and private not-for-profit facilities had a higher likelihood of being newly diagnosed with HIV. Strengthening HIV services at these facilities and outreach to populations that use them could help to close the HIV diagnosis gap.
摘要：
通过将重点放在高产人群上，并确定未确诊的艾滋病毒感染者更有可能参加的医疗机构类型，可以提高艾滋病毒检测效率。
对肯尼亚西部结核病/艾滋病主动病例发现综合干预期间收集的数据进行回顾性队列分析。对2018年7月1日至12月31日期间报告结核病提示症状并在症状筛查后一个月内获得艾滋病毒检测结果的个人的数据进行了分析。我们使用逻辑回归和对县级以下数据进行调整的一般估计方程，以确定新的HIV诊断的医疗机构水平预测因子。
在143个医疗机构中确定的11,376名成年人中，1038（9％）检测出HIV阳性。每个医疗机构的HIV阳性中位数为6％（IQR=2-15％）。与政府机构相比，有结核病症状的患者在私人非营利机构中获得新的HIV诊断的可能性是政府机构的三倍以上（调整后优势比（aOR）3.40；95％CI=1.96-5.90）。在医院接受检测的患者获得新艾滋病毒诊断的可能性是在较小设施接受检测的患者的两倍多(即，保健中心和药房）（aOR2.26；95%CI=1.60-3.21）。
在大型医疗机构和私人非营利机构就诊的推定结核病患者，新诊断为HIV的可能性更高。加强这些设施的艾滋病毒服务，并向使用这些服务的人群进行宣传，可以帮助缩小艾滋病毒诊断差距。
对肯尼亚西部结核病/艾滋病主动病例发现综合干预期间收集的数据进行回顾性队列分析。对2018年7月1日至12月31日期间报告结核病提示症状并在症状筛查后一个月内获得艾滋病毒检测结果的个人的数据进行了分析。我们使用逻辑回归和对县级以下数据进行调整的一般估计方程，以确定新的HIV诊断的医疗机构水平预测因子。
在143个医疗机构中确定的11,376名成年人中，1038（9％）检测出HIV阳性。每个医疗机构的HIV阳性中位数为6％（IQR=2-15％）。与政府机构相比，有结核病症状的患者在私人非营利机构中获得新的HIV诊断的可能性是政府机构的三倍以上（调整后优势比（aOR）3.40；95％CI=1.96-5.90）。在医院接受检测的患者获得新艾滋病毒诊断的可能性是在较小设施接受检测的患者的两倍多(即，保健中心和药房）（aOR2.26；95%CI=1.60-3.21）。
在大型医疗机构和私人非营利机构就诊的推定结核病患者，新诊断为HIV的可能性更高。加强这些设施的艾滋病毒服务，并向使用这些服务的人群进行宣传，可以帮助缩小艾滋病毒诊断差距。
