HPTN071(PopART)是赞比亚和南非的一项三臂社区随机试验,评估了组合HIV预防方案的影响。包括通用测试和治疗(UTT),关于艾滋病毒发病率。这项嵌套研究在HPTN071(PopART)试验的干预社区中,在UTT的背景下,研究了与及时联系护理和ART启动(TLA)(即转诊后六个月内)相关的因素。
在社区艾滋病毒护理提供者(CHiPs)通过挨家挨户进行的PopART干预措施的第一年中,被确定为艾滋病毒感染者(PLWH)(未接受抗逆转录病毒治疗(ART))的7572人中,实现TLA的个体(对照)和未实现TLA的个体(病例),按性别和社区分层,被随机选中重新联系面试。采用标准化问卷探索与TLA潜在相关的因素,包括人口统计学和行为特征,以及参与者对艾滋病毒和相关服务的意见。使用多变量逻辑回归估计比较病例和对照的赔率。
分析了来自705名参与者(333例/372名对照)的数据。根据人口统计学特征,包括年龄,病例和对照之间的差异可以忽略不计,婚姻或社会经济地位。先前对CHiPs的熟悉会促进TLA(病例的aOR:0.58,95%CI:0.39至0.86,p=0.006)。发现诊所过度拥挤(aOR:1.51,95%CI:1.08至2.12,p=0.006)或开放时间不便(aOR:1.63,95%CI:1.06至2.51,p=0.02)的参与者不太可能达到TLA,那些对感染艾滋病毒表现出更强烈的羞耻感的人也是如此(ptrend=0.007)。表达“没有准备好”(aOR:2.75,95%CI:1.89至4.01,p<0.001)并宁愿等到他们感到不适(aOR:2.00,95%CI:1.27至3.14,p=0.02)也同样表明是病例。担心在诊所就诊或工作人员如何治疗患者与TLA无关。虽然协会并不强大,我们发现,自我报告的终生性伴侣数量越多,参与者达到TLA的可能性就越大(ptrend=0.06).有一些证据表明,接受ART的HIV阳性伴侣的参与者不太可能出现病例(aOR:0.75,95%CI:0.53至1.06,p=0.07)。
病例和控制之间缺乏社会人口统计学差异,这对于“普遍”干预措施是令人鼓舞的,该干预措施旨在确保整个社区的高覆盖率。使诊所更加“对患者友好”,可以进一步提高治疗效果。那些具有较高风险行为的人更积极地参与UTT的发现为预防治疗带来了希望。
HPTN 071 (PopART) is a three-arm community randomized trial in Zambia and South Africa evaluating the impact of a combination HIV prevention package, including universal test and treat (UTT), on HIV incidence. This nested study examined factors associated with timely linkage-to-care and ART initiation (TLA) (i.e. within six-months of referral) in the context of UTT within the intervention communities of the HPTN 071 (PopART) trial.
Of the 7572 individuals identified as persons living with HIV (PLWH) (and not on antiretroviral treatment (ART)) during the first year of the PopART intervention provided by Community HIV-care Providers (CHiPs) through door-to-door household visits, individuals who achieved TLA (controls) and those who did not (cases), stratified by gender and community, were randomly selected to be re-contacted for interview. Standardized questionnaires were administered to explore factors potentially associated with TLA, including demographic and behavioural characteristics, and participants\' opinions on HIV and related services. Odds ratios comparing cases and controls were estimated using a multi-variable logistic regression.
Data from 705 participants (333 cases/372 controls) were analysed. There were negligible differences between cases and controls by demographic characteristics including age, marital or socio-economic position. Prior familiarity with the CHiPs encouraged TLA (aOR of being a
case: 0.58, 95% CI: 0.39 to 0.86, p = 0.006). Participants who found clinics overcrowded (aOR: 1.51, 95% CI: 1.08 to 2.12, p = 0.006) or opening hours inconvenient (aOR: 1.63, 95% CI: 1.06 to 2.51, p = 0.02) were less likely to achieve TLA, as were those expressing stronger feelings of shame about having HIV (ptrend = 0.007). Expressing \"not feeling ready\" (aOR: 2.75, 95% CI: 1.89 to 4.01, p < 0.001) and preferring to wait until they felt sick (aOR: 2.00, 95% CI: 1.27 to 3.14, p = 0.02) were similarly indicative of being a
case. Worrying about being seen in the clinic or about how staff treated patients was not associated with TLA. While the association was not strong, we found that the greater the number of self-reported lifetime sexual partners the more likely participants were to achieve TLA (ptrend = 0.06). There was some evidence that participants with HIV-positive partners on ART were less likely to be cases (aOR: 0.75, 95% CI: 0.53 to 1.06, p = 0.07).
The lack of socio-demographic differences between cases and controls is encouraging for a \"universal\" intervention that seeks to ensure high coverage across whole communities. Making clinics more \"patient-friendly\" could enhance treatment uptake further. The finding that those with higher risk behaviour are more actively engaging with UTT holds promise for treatment-as-prevention.