肯尼亚蒙巴萨县计划生育诊所开展推荐的艾滋病毒咨询和检测服务的表现：一项横断面研究。
Performance of family planning clinics in conducting recommended HIV counseling and testing in Mombasa County, Kenya: a cross-sectional study.
机构信息
Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
出版信息
BMC Health Serv Res. 2019 Sep 14;19(1):665. doi: 10.1186/s12913-019-4519-x.
BACKGROUND
A high proportion of African women utilize family planning (FP) services. Accordingly, incorporating HIV testing into FP services may strategically target the first WHO 90-90-90 goal of 90% of people living with HIV knowing their status.
METHODS
The objective of this analysis was to determine the proportion of new FP clients counseled and tested for HIV, as well as correlates of HIV testing, in a random sample of 58 FP clinics in Mombasa County, Kenya. Structured interviews of FP clinic managers collected data on characteristics of FP clinics and staff. Study staff performed a 3-month review of FP registers, summarizing new client HIV testing and counseling (HTC). Because overall rates of HTC were quite low, a binary variable was created comparing clinics performing any HIV counseling and/or testing to clinics performing none. Generalized linear models were used to calculate prevalence ratios (PR) and identify correlates of HTC. Factors associated with any HTC with a p-value < 0.10 in univariate analysis were included in a multivariate analysis.
RESULTS
Of the 58 FP clinics, 26 (45%) performed any counseling for HIV testing, and 23 (40%) performed any HIV testing. Counseling for HIV testing was conducted for 815/4389 (19%) new clients, and HIV testing was performed for 420/4389 (10%). Clinics without trained HIV testing providers uniformly did not conduct HIV counseling and/or testing (0/12 [0%]), while 27/46 (59%) of clinics with ≥1 provider performed some HTC (p < 0.001). In the subset of 46 clinics with ≥1 trained HIV testing provider, correlates of performing HTC included being a public versus non-public clinic (PR 1.70 95%CI 1.01-2.88), and having an HIV comprehensive care center (CCC) onsite (PR 2.05, 95%CI 1.04-4.06).
CONCLUSION
Trained HIV testing providers are crucial for FP clinics to perform any HTC. Approaches are needed to increase routine HTC in FP clinics including staffing changes and/or linkages with other testing services (in standalone VCT services or lab facilities) in order to improve the implementation of existing national guidelines. A future cluster randomized trial is planned to test an implementation strategy, the Systems Analysis and Improvement Approach (SAIA) to increase HTC in FP clinics.
背景
相当比例的非洲妇女利用计划生育（FP）服务。因此，将 HIV 检测纳入 FP 服务中，可能是战略性地实现世卫组织前 90-90-90 目标的第一步，即 90%的 HIV 感染者知晓其感染状况。
方法
本分析的目的是确定在肯尼亚蒙巴萨县随机抽取的 58 家 FP 诊所中，接受 FP 服务的新客户接受 HIV 咨询和检测的比例，以及 HIV 检测的相关因素。FP 诊所经理的结构访谈收集了 FP 诊所和工作人员特征的数据。研究人员对 FP 登记册进行了为期 3 个月的回顾，总结了新客户的 HIV 检测和咨询（HTC）情况。由于整体 HTC 率相当低，因此创建了一个二进制变量，将进行任何 HIV 咨询和/或检测的诊所与未进行任何 HIV 咨询和/或检测的诊所进行比较。使用广义线性模型计算患病率比（PR）并确定 HTC 的相关因素。单变量分析中 p 值 < 0.10 的任何 HTC 相关因素均纳入多变量分析。
结果
在 58 家 FP 诊所中，26 家（45%）提供了任何 HIV 检测咨询，23 家（40%）提供了任何 HIV 检测。对 4389 名新客户中的 815 名（19%）进行了 HIV 检测咨询，对 4389 名新客户中的 420 名（10%）进行了 HIV 检测。没有经过 HIV 检测培训的提供者的诊所无一例外地不进行 HIV 咨询和/或检测（0/12 [0%]），而有≥1 名提供者的 27/46 家（59%）诊所则进行了部分 HTC（p < 0.001）。在有≥1 名经过培训的 HIV 检测提供者的 46 家诊所中，进行 HTC 的相关因素包括是公立诊所还是非公立诊所（PR 1.70，95%CI 1.01-2.88），以及是否有 HIV 综合关怀中心（CCC）（PR 2.05，95%CI 1.04-4.06）。
结论
经过培训的 HIV 检测提供者对于 FP 诊所进行任何形式的 HTC 都至关重要。需要采取措施，包括改变人员配置，以及与其他检测服务（在独立的 VCT 服务或实验室设施中）建立联系，以增加 FP 诊所中的常规 HTC，从而改进现有国家指南的实施。计划开展一项未来的集群随机试验，以测试一种实施策略，即系统分析和改进方法（SAIA），以增加 FP 诊所中的 HTC。
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