Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention
Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention
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DOI：
10.1016/s0140-6736(13)62230-8
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发表时间：
2014-07-19
期刊：
影响因子：
168.9
通讯作者：
Dybul, Mark
中科院分区：
文献类型：
--
作者：
Jones, Alexandra;Cremin, Ide;Dybul, Mark
据报告，自2001年以来，艾滋病毒发病率大幅下降，艾滋病毒预防方面的科学进展为进一步降低发病率带来了强烈希望。现在是时候用公共卫生的综合预防办法取代寻求所谓的银，这种办法认识到风险的分布并不均匀，有效的干预措施可能因风险状况而异。不同的国家有不同的微流行病，传播水平和风险群体也大不相同，并随着时间的推移而变化。因此，重点应放在高传播地区、艾滋病毒风险最高的人群以及最有可能对每种不同的微流行病产生最大影响的一揽子干预措施上。在改变行为、使用避孕套和医疗男性包皮环切术以及扩大对感染者使用抗逆转录病毒药物和对未感染者高危接触前预防的基础上，现在可以考虑公共卫生史上最显著成就之一的前景：将艾滋病毒传播从大流行病减少到低水平的地方病。
Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.