Rethinking the role of the local community in HIV epidemic spread in sub-Saharan Africa: a proximate-determinants approach
Rethinking the role of the local community in HIV epidemic spread in sub-Saharan Africa: a proximate-determinants approach
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DOI：
10.2217/hiv.09.33
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发表时间：
2009-09-01
期刊：
影响因子：
--
通讯作者：
Tanser, Frank
中科院分区：
文献类型：
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作者：
Baernighausen, Till;Tanser, Frank
艾滋病毒在撒哈拉以南非洲的传播在很大程度上有增无减。为了改进预防干预措施，需要更好地了解艾滋病毒感染的决定因素。概念框架可以指导流行病学调查，防止被误导的孤立地关注单一风险因素。现有的艾滋病毒感染框架侧重于传播。然而，传播者很少为人所知。相比之下，关于个人艾滋病毒感染的数据可以从对最近艾滋病毒感染的纵向研究和测试中获得。从易感染艾滋病毒的个人的角度来看，重要的是要区分决定个人生物学倾向和性行为的因素和社区一级的因素，这些因素既会影响艾滋病毒的感染，也会影响从社区中选择的性伴侣感染艾滋病毒并传播感染的可能性。我们提出了一个框架，以易感个体为起点，在个人和社区层面将艾滋病毒感染的远端、近端和生物决定因素联系起来。我们描述了使用该框架的三个必要要素(相关社区的识别、多层次分析和因果推理方法)。
The spread of HIV in sub-Saharan Africa continues largely unabated. To improve prevention interventions, a better understanding of the determinants of HIV infection is required. Conceptual frameworks can guide epidemiological investigation and prevent a misguided focus on single risk factors in isolation. Existing frameworks of H IV infection focus on transmission. However, the transmitting individual is rarely known. By contrast, data on individual HIV acquisition are available from longitudinal studies and tests for recent HIV infection. From the perspective of individuals susceptible to HIV, it is important to distinguish between factors determining the individual's biological disposition and sexual behavior and community-level factors, which can affect both HIV acquisition and the likelihood that a sex partner chosen from a community will be infected with HIV and transmit the infection. We propose a framework that takes the susceptible individual as a starting point and links distal, proximate and biological determinants of HIV infection at both the individual and the community level. We describe three necessary ingredients for the use of the framework (identification of the relevant community, multilevel analysis and methods for causal inference).