为了帮助诊断和启动抗逆转录病毒治疗(ART)≥95%的艾滋病毒感染者(PLHIV),世界卫生组织(WHO)建议为生物儿童提供艾滋病毒检测,以及所有PLHIV的性和针头分享伙伴(指数客户测试,ICT)。许多索引客户端,然而,不识别或没有可联系的合作伙伴,通常,在指数检测后不久,不到95%的HIV阳性伴侣开始ART。为了帮助改善埃斯瓦蒂尼(以前的斯威士兰)的早期艾滋病毒诊断和ART启动,我们实施了基于社区的艾滋病毒检测和同行交付,联系案例管理计划(CommLink),提供ICT作为世卫组织建议的联系服务的综合一揽子计划的一部分。CommLink于2015年6月-2017年3月(第一阶段)实施,和2017年4月-2018年9月(第二阶段)。除了亲生孩子和伴侣,向成年家庭成员(第一阶段和第二阶段)以及包括CommLink索引客户的朋友和熟人(第二阶段)在内的高风险同事提供了艾滋病毒检测。与第一阶段相比,在第二阶段,更多的CommLink客户向伴侣或家庭成员披露了他们的HIV感染状况[94%(562/598)与75%(486/652)],并且有≥1个伴侣,家庭成员,或通过CommLink测试的高风险员工(联系人)[41%(245/598)与18%(117/652)]。在测试的537个触点中,253人(47%)是艾滋病毒阳性,目前没有接受艾滋病毒护理。包括17%(17/100)年龄<15岁的家庭成员,42%(78/187)年龄≥15岁的非伴侣家庭成员,60%(73/121)的性伴侣,和66%(85/129)的高风险员工。在参与CommLink的210名年龄≥15岁的HIV阳性接触者中,几乎所有人都获得了推荐的联系服务,包括治疗导航(95%),每周电话随访(93%),和≥3次咨询会议(94%);同伴咨询师解决了76%(306/404)的已确定的护理障碍(例如,感知健康);200(95%)在医疗机构发起ART,其中196人(98%)在病例管理服务结束前至少接受了一次抗逆转录病毒治疗。为了帮助各国在所有PLHIV中实现≥90%的ART覆盖率,为指数客户的成年家庭成员和高风险同事扩展ICT,并为所有已确定的PLHIV提供同行交付的联系病例管理,应该考虑。
To help diagnose and initiate antiretroviral therapy (ART) for ≥95% of all persons living with HIV (PLHIV), the World Health Organization (WHO) recommends offering HIV testing to biological children, and sexual and needle-sharing partners of all PLHIV (index-client testing, ICT). Many index clients, however, do not identify or have contactable partners, and often substantially fewer than 95% of HIV-positive partners initiate ART soon after index testing. To help improve early HIV diagnosis and ART initiation in
Eswatini (formerly Swaziland), we implemented a community-based HIV testing and peer-delivered, linkage
case management program (CommLink) that provided ICT as part of a comprehensive package of WHO recommended linkage services. CommLink was implemented June 2015 -March 2017 (Phase I), and April 2017 -September 2018 (Phase II). In addition to biological children and partners, HIV testing was offered to adult family members (Phases I and II) and high-risk associates including friends and acquaintances (Phase II) of CommLink index clients. Compared with Phase I, in Phase II proportionally more CommLink clients disclosed their HIV-infection status to a partner or family member [94% (562/598) vs. 75% (486/652)], and had ≥1 partners, family members, or high-risk associates (contacts) tested through CommLink [41% (245/598) vs. 18% (117/652)]. Of 537 contacts tested, 253 (47%) were HIV-positive and not currently in HIV care, including 17% (17/100) of family members aged <15 years, 42% (78/187) of non-partner family members aged ≥15 years, 60% (73/121) of sexual partners, and 66% (85/129) of high-risk associates. Among 210 HIV-positive contacts aged ≥15 years who participated in CommLink, nearly all received recommended linkage services including treatment navigation (95%), weekly telephone follow-up (93%), and ≥3 counseling sessions (94%); peer counselors resolved 76% (306/404) of identified barriers to care (e.g., perceived wellness); and 200 (95%) initiated ART at a healthcare facility, of whom 196 (98%) received at least one antiretroviral refill before
case-management services ended. To help countries achieve ≥90% ART coverage among all PLHIV, expanding ICT for adult family members and high-risk associates of index clients, and providing peer-delivered linkage
case management for all identified PLHIV, should be considered.