Comparative assessment of five trials of universal HIV testing and treatment in sub-Saharan Africa.
Comparative assessment of five trials of universal HIV testing and treatment in sub-Saharan Africa.
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DOI：
10.1002/jia2.25048
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发表时间：
2018-01
影响因子：
6
通讯作者：
Universal Test and Treat Trials Consortium (UT3C)
中科院分区：
文献类型：
--
作者：
Perriat D;Balzer L;Hayes R;Lockman S;Walsh F;Ayles H;Floyd S;Havlir D;Kamya M;Lebelonyane R;Mills LA;Okello V;Petersen M;Pillay D;Sabapathy K;Wirth K;Orne-Gliemann J;Dabis F;Universal Test and Treat Trials Consortium (UT3C)
普及自愿艾滋病毒咨询和检测，然后迅速开始对所有被诊断为艾滋病毒感染者的人进行抗逆转录病毒疗法(普遍检测和治疗，UTT)现在是一项全球卫生标准。然而，它在人口层面的影响、可行性和成本仍然未知。在撒哈拉以南非洲实施了五项以社区为基础的试验，以衡量各种UTT战略在人口层面的效果：博茨瓦纳的BCPP/YaTsie、斯威士兰的MAX ART、南非和赞比亚的HPTN 071(PopART)、乌干达和肯尼亚的SEARCH以及南非的ANRS 12249 TASP。本报告描述和对比了与这五项UTT试验相关的背景、研究方法、干预方案、探索的主题、研究设计的演变和干预措施。我们使用从研究方案中提取并在基线研究期间收集的数据对这五个试验进行了比较评估，并从研究调查人员那里获得了额外的信息。我们在五个类别中组织了试验的差异和共性：试验背景、研究设计、干预方案、试验主题和改编。所有这些试验都是在普遍的艾滋病毒流行背景下进行的，在社会、人口、经济、政治和卫生系统环境中有很大的不同。它们的共同目标是评估UTT对艾滋病毒流行的影响，但在研究设计和试验人群的资格标准等方法方面存在差异。除了普遍启动抗逆转录病毒治疗，这些试验还提供了广泛的生物医学、行为和结构干预措施，作为其UTT战略的一部分。这五项研究探讨了共同的问题，包括试验服务的接受率和个人健康结果。自启动以来，所有试验都适应了不断变化的政治、经济和公共卫生背景，包括通过了一系列关于启动抗逆转录病毒治疗的国家建议。我们发现五个UTT试验在设计、实施和多学科产出方面有很大的共同点，但也存在差异。由于关于UTT如何在人群水平上提高艾滋病毒护理的效率和质量的实证文献仍然稀缺，本文为更多关于UTT的合作研究提供了基础，并支持国家和国际艾滋病毒护理的循证决策。
Universal voluntary HIV counselling and testing followed by prompt initiation of antiretroviral therapy (ART) for all those diagnosed HIV‐infected (universal test and treat, UTT) is now a global health standard. However, its population‐level impact, feasibility and cost remain unknown. Five community‐based trials have been implemented in sub‐Saharan Africa to measure the effects of various UTT strategies at population level: BCPP/YaTsie in Botswana, Max ART in Swaziland, HPTN 071 (PopART) in South Africa and Zambia, SEARCH in Uganda and Kenya and ANRS 12249 TasP in South Africa. This report describes and contrasts the contexts, research methodologies, intervention packages, themes explored, evolution of study designs and interventions related to each of these five UTT trials. We conducted a comparative assessment of the five trials using data extracted from study protocols and collected during baseline studies, with additional input from study investigators. We organized differences and commonalities across the trials in five categories: trial contexts, research designs, intervention packages, trial themes and adaptations. All performed in the context of generalized HIV epidemics, the trials highly differ in their social, demographic, economic, political and health systems settings. They share the common aim of assessing the impact of UTT on the HIV epidemic but differ in methodological aspects such as study design and eligibility criteria for trial populations. In addition to universal ART initiation, the trials deliver a wide range of biomedical, behavioural and structural interventions as part of their UTT strategies. The five studies explore common issues, including the uptake rates of the trial services and individual health outcomes. All trials have adapted since their initiation to the evolving political, economic and public health contexts, including adopting the successive national recommendations for ART initiation. We found substantial commonalities but also differences between the five UTT trials in their design, conduct and multidisciplinary outputs. As empirical literature on how UTT may improve efficiency and quality of HIV care at population level is still scarce, this article provides a foundation for more collaborative research on UTT and supports evidence‐based decision making for HIV care in country and internationally.
影响因子：
3.3
作者：
Adams, Alfred;Moyer, Eileen
通讯作者：
Moyer, Eileen