Reductions in risk behaviour provide the most consistent explanation for declining HIV-1 prevalence in Uganda
Reductions in risk behaviour provide the most consistent explanation for declining HIV-1 prevalence in Uganda
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DOI：
10.1097/00002030-199902250-00012
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发表时间：
1999-02-25
期刊：
影响因子：
3.8
通讯作者：
von Sonnenburg, F
中科院分区：
文献类型：
--
作者：
Kilian, AHD;Gregson, S;von Sonnenburg, F
目的：为了监测艾滋病毒-1在乌干达西部的流行和干预措施的可能影响。设计：从哨点监测艾滋病毒-1血清阳性率的结果进行了比较，与横断面血清调查数据和模型模拟。1991年至1997年期间，波特尔堡镇产前诊所就诊者中艾滋病毒-1流行率的特定性别趋势，分析了自1991年以来实施艾滋病综合控制方案的国家和地区的艾滋病毒/艾滋病感染情况。结果进行了比较，从一个数学模型模拟艾滋病毒-1在乌干达流行的输出。模拟了两种情况。一个没有，一个有行为改变。结果：3271名ANC参加者的数据表明，较高的教育程度和单身是HIV-1感染的危险因素。据观察，随着时间的推移，受过中学教育的妇女的风险显著降低，而文盲妇女的风险仍然很高。在15-19岁的妇女（n = 1 045）中，经教育和婚姻状况调整的艾滋病毒-1流行率从1991年的32.2%稳步下降到1997年的10.3%。在20至24岁的妇女中（n = 1 010），艾滋病毒-1的流行率在1993年之前从19.9%上升到31.7%，此后有所下降（1997年为21.7%）。这些趋势与假设行为改变的模型模拟预测密切相关，1995-1997年，HIV-1流行率估计数的置信区间排除了未受影响流行病的模型输出。在老年妇女（n = 1216）中没有发现明显的HIV-1流行趋势，与模型的比较也不明确。人口调查时的哨点监测数据密切反映了两个较年轻年龄组（15-19岁和20-24岁）的女性总人口抽样结果。相比之下，25-29岁的孕妇表现出显着低于人口样本（20.8%对45.1%holds.Conclusion：HIV-1的患病率之间的ANC出席者年龄在15-24岁，可用于监测HIV-1的流行在给定的设置。15-19岁和20-24岁妇女中艾滋病毒-1流行率的下降趋势很可能与行为改变导致的艾滋病毒-1发病率下降相对应。我们的数据还表明，哨点监测数据需要进行年龄分层，以提供有用的信息。(C)1999年利平科特威廉姆斯和威尔金斯。
Objective: To monitor the HIV-1 epidemic in Western Uganda and the possible impact of interventions.Design: Results from sentinel surveillance of HIV-1 seroprevalence were compared with cross-sectional serosurvey data and model simulations.Methods: Age-specific trends in HIV-1 prevalence between 1991 and 1997 amongst antenatal clinic (ANC) attenders in the town of Fort Portal, where a comprehensive AIDS control programme has been implemented since 1991, were analysed. Results were compared with outputs from a mathematical model simulating the HIV-1 epidemic in Uganda. Two scenarios were modelled. one without and one with behaviour change. Sentinel surveillance data were compared with data from a population-based HIV-1 serosurvey at the study site, which was carried out in early 1995.Results: Data from 3271 ANC attenders identified greater education and being single as risk factors for HIV-1 infection. A significant decrease of risk for women with secondary school education over time was observed, whereas the risk for illiterate women remained high. Among women aged 15-19 years (n = 1045) education and marital status-adjusted HIV-1 prevalence declined steadily from 32.2% in 1991 to 10.3% in 1997. For 20-24-year-old women (n = 1010) HIV-1 prevalence increased until 1993 from 19.9% to 31.7% and decreased thereafter (21.7% in 1997). These trends closely follow the prediction of the model simulation assuming behaviour change, and for 1995-1997, confidence intervals of the HIV-1 prevalence estimate exclude the model output for an uninfluenced epidemic. No clear trends of HIV-1 prevalence were found in older women (n = 1216) and comparisons with the model were ambiguous. Sentinel surveillance data at the time of the population survey closely reflected results for the female general population sample for the two younger age-groups (15-19 and 20-24 years). In contrast, pregnant women aged 25-29 years showed significantly lower rates than the population sample (20.8% versus 45.1%).Conclusion: HIV-1 prevalence amongst ANC attenders aged 15-24 years can be used to monitor the HIV-1 epidemic in the given setting. Declining trends of HIV-1 prevalence in women aged 15-19 and 20-24 years most likely correspond to a reduced HIV-1 incidence attributable to changes in behaviour. Our data also show that sentinel surveillance data need to be age-stratified to give useful information. (C) 1999 Lippincott Williams ei Wilkins.