Index participant characteristics and HIV assisted partner services efficacy in Kenya: results of a cluster randomized trial.

Autor: Masyuko SJ; National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya.; Department of Global Health, University of Washington, Seattle, WA, USA., Cherutich PK; Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya., Contesse MG; Department of Epidemiology, University of Washington, Seattle, WA, USA., Maingi PM; VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya., Wamuti BM; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya., Macharia PM; National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya., Bukusi DE; VCT and HIV Prevention Unit, Kenyatta National Hospital, Nairobi, Kenya., Otieno FA; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya., Spiegel HM; Department of Health and Human Services, Kelly Government Solutions, Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA., Dunbar MD; Department of Computer Science and Demography, University of Washington, Seattle, WA, USA., Golden MR; Department of Medicine, University of Washington, Seattle, WA, USA., Richardson BA; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Biostatistics, University of Washington, Seattle, WA, USA., Farquhar C; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Epidemiology, University of Washington, Seattle, WA, USA.; Department of Medicine, University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2019 Jul; Vol. 22 Suppl 3, pp. e25305.
DOI: 10.1002/jia2.25305
Abstrakt: Introduction: We have previously demonstrated that assisted partner services (aPS) increases HIV testing and case finding among partners of persons living with HIV (PLHIV) in a cluster randomized trial in Kenya. However, the efficacy of aPS may vary across populations. In this analysis, we explore differences in aPS efficacy by characteristics of index participants.
Methods: Eighteen HIV testing sites were randomized to immediate versus 6-week delayed aPS. Participants were PLHIV (or index participants) and their sexual partners. Partners of index participants were contacted for HIV testing and linked to care if HIV positive. Primary outcomes were the number of partners per index participant who: 1) tested for HIV, 2) tested HIV positive and 3) enrolled in HIV care. We used generalized estimating equations to assess differences in aPS efficacy by region, testing location, gender, age and knowledge of HIV status.
Results: From 2013 to 2015, the study enrolled 1119 index participants, 625 of whom were in the immediate group. These index participants named 1286 sexual partners. Immediate aPS was more efficacious than delayed aPS in promoting HIV testing among partners in high compared to low HIV prevalence regions (Nyanza incidence rate ratio (IRR) 7.2; 95% confidence interval (CI) 5.4, 9.6 vs. Nairobi/Central IRR 3.4 95% CI 2.3, 4.8). Higher rates of partner HIV testing were also observed for index participants in rural/peri-urban compared to urban sites (IRR 6.6; 95% CI 4.5, 9.6 vs. IRR 3.5 95% CI 2.5, 5.0 respectively), for female versus male index participants (IRR 5.8 95% CI 4.2, 7.9 vs. IRR 3.7; 95% CI 2.4, 5.8 respectively) and for newly diagnosed versus known HIV-positive index participants (IRR 6.0 95% CI 4.2, 8.7 vs. IRR 3.3; 95% CI 2.0, 7.7 respectively). Providing aPS to female versus male index participants also had a significantly higher HIV case finding rate (IRR 9.1; 95% CI 4.0, 20.9 vs. IRR 3.2 95% CI 1.7, 6.0 respectively.) CONCLUSIONS: While it is known that aPS promotes increases in HIV testing and case finding, this is the first study to demonstrate significant differences in aPS efficacy across characteristics of the index participant. Understanding these differences and their drivers will be critical as aPS is brought to scale in order to ensure all PLHIV have access to these services.
(© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
Databáze: MEDLINE
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