Steep Declines in Pediatric AIDS Mortality in South Africa, Despite Poor Progress Toward Pediatric Diagnosis and Treatment Targets.
Steep Declines in Pediatric AIDS Mortality in South Africa, Despite Poor Progress Toward Pediatric Diagnosis and Treatment Targets.
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DOI：
10.1097/inf.0000000000002680
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Davies MA
中科院分区：
文献类型：
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作者：
Johnson LF;Patrick M;Stephen C;Patten G;Dorrington RE;Maskew M;Jamieson L;Davies MA
很少有人尝试监测儿童艾滋病毒诊断和抗逆转录病毒治疗 (ART) 覆盖目标的进展，以及 ART 和预防母婴传播 (PMTCT) 计划对儿童艾滋病毒发病率和死亡率的影响。采用多参数证据综合方法来整合南非儿科艾滋病毒数据源。南非先前开发的艾滋病毒模型根据家庭调查艾滋病毒患病率数据、常规抗体检测数据、接受抗逆转录病毒治疗的儿童人数和年龄数据、人口动态登记数据以及死亡时艾滋病毒诊断数据进行了校准。通过将经过验证的模型输出与在没有 ART 和 PMTCT 的情况下预期的趋势模型预测进行比较来估计 ART 和 PMTCT 的影响。到 2018 年中期，该模型估计 HIV 阳性儿童的诊断率为 75.2%（95% CI：73.9-76.8%），远低于 HIV 阳性成人的相应估计值（91.0%）。 2018 年儿童的 ART 覆盖率（51.2%，95% CI：49.4–52.7%）也低于成人（62.0%）。 2017-18 年，母婴传播新病例和儿童艾滋病死亡人数相对于不采取干预措施的情况下的预期分别减少了 84% 和 94%，但死亡率的下降主要是由预防母婴传播推动的。尽管南非儿童艾滋病死亡率大幅下降，但这主要归功于预防母婴传播计划的成功，而且与成人相比，实现 90-90-90 目标的进展似乎相对较差。
Few attempts have been made to monitor progress towards HIV diagnosis and antiretroviral treatment (ART) coverage targets in children, and the impact that ART and prevention of mother-to-child transmission (PMTCT) programs have had on pediatric HIV incidence and mortality. A multi-parameter evidence synthesis approach was adopted to integrate South African pediatric HIV data sources. A previously-developed model of HIV in South Africa was calibrated to household survey HIV prevalence data, routine antibody testing data, data on numbers and ages of children on ART, vital registration data and data on HIV diagnosis at death. The impact of ART and PMTCT was estimated by comparing validated model outputs against model predictions of the trends that would have been expected in the absence of ART and PMTCT. By mid-2018, the model estimated that 75.2% (95% CI: 73.9–76.8%) of HIV-positive children were diagnosed, substantially lower than the corresponding estimates in HIV-positive adults (91.0%). ART coverage in children in 2018 (51.2%, 95% CI: 49.4–52.7%) was also lower than that in adults (62.0%). In 2017–18, the numbers of new cases of mother-to-child transmission and pediatric AIDS deaths were reduced by 84% and 94% respectively, relative to what would have been expected in the absence of interventions, but reductions in mortality were driven largely by PMTCT. Although levels of AIDS mortality in children have declined dramatically in South Africa, this has mostly been due to successful PMTCT programs, and progress towards the 90–90-90 targets appears relatively poor when compared to that in adults.
DOI：
10.1097/01.aids.0000432987.53271.40
发表时间：
2013-10-23
期刊：
AIDS (London, England)
影响因子：
--
作者：
Kerber KJ;Lawn JE;Johnson LF;Mahy M;Dorrington RE;Phillips H;Bradshaw D;Nannan N;Msemburi W;Oestergaard MZ;Walker NP;Sanders D;Jackson D
通讯作者：
Jackson D