HIV Treatment in Resource-Limited Environments: Treatment Coverage and Insights.
HIV Treatment in Resource-Limited Environments: Treatment Coverage and Insights.
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资源有限环境中的艾滋病毒治疗：治疗覆盖范围和见解。
DOI：
10.1016/j.jval.2015.10.003
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Roberts,MarkS
中科院分区：
文献类型：
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作者：
Khademi,Amin;Saure,Denis;Schaefer,Andrew;Nucifora,Kimberly;Braithwaite,RScott;Roberts,MarkS
背景抗逆转录病毒治疗对HIV流行的影响是复杂的。艾滋病毒感染者接受治疗后存活时间更长，但传播疾病的可能性较小。标准的覆盖率随着未经治疗的个体的死亡而改进，没有考虑到一些人可能在接受治疗之前感染疾病并死亡的事实，这使得它容易高估抗逆转录病毒治疗计划的长期表现。目的是提出一个替代的覆盖率定义，以更好地衡量HIV治疗计划的长期表现。为了从数值上比较这些定义，我们扩展了HIV疾病和治疗的模拟模型，以表示包括未感染和感染HIV的个体在内的动态人口。此外，我们还估计了在资源有限的情况下实施各种治疗政策所需的额外资源。结果在60万人的合成人口中，其中44,000人(7.6%)感染，并有资格接受CD4计数低于500个/mm3的治疗，假设世界卫生组织(WHO)定义的覆盖率为50%符合条件的人，并用单一治疗方案治疗这些人，目前的WHO覆盖率定义与我们建议的在10年规划范围内的差距高达16%。结论基于累积发病率的覆盖率定义更准确地反映了长期治疗成功，并与WHO和其他覆盖率定义一起提供了对HIV治疗进展的更好了解。
BackgroundThe effects of antiretroviral treatment on the HIV epidemic are complex. HIV-infected individuals survive longer with treatment, but are less likely to transmit the disease. The standard coverage measure improves with the deaths of untreated individuals and does not consider the fact that some individuals may acquire the disease and die before receiving treatment, making it susceptible to overestimating the long-run performance of antiretroviral treatment programs.ObjectiveThe objective was to propose an alternative coverage definition to better measure the long-run performance of HIV treatment programs.MethodsWe introduced cumulative incidence–based coverage as an alternative to measure an HIV treatment program’s success. To numerically compare the definitions, we extended a simulation model of HIV disease and treatment to represent a dynamic population that includes uninfected and HIV-infected individuals. Also, we estimated the additional resources required to implement various treatment policies in a resource-limited setting.ResultsIn a synthetic population of 600,000 people of which 44,000 (7.6%) are infected, and eligible for treatment with a CD4 count of less than 500 cells/mm3, assuming a World Health Organization (WHO)-defined coverage rate of 50% of eligible people, and treating these individuals with a single treatment regimen, the gap between the current WHO coverage definition and our proposed one is as much as 16% over a 10-year planning horizon.ConclusionsCumulative incidence–based definition of coverage yields a more accurate representation of the long-run treatment success and along with the WHO and other definitions of coverage provides a better understanding of the HIV treatment progress.