Interrupting HIV transmission networks: how can we design and implement timely and effective interventions?
Interrupting HIV transmission networks: how can we design and implement timely and effective interventions?
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阻断艾滋病毒传播网络：我们如何设计和实施及时有效的干预措施？
DOI：
10.1080/14787210.2023.2221850
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发表时间：
2023
影响因子：
5.7
通讯作者：
Mobley,Victoria
中科院分区：
文献类型：
--
作者：
Dennis,AnnM;Mobley,Victoria
虽然在过去十年中，通过广泛获得和使用抗逆转录病毒药物，在艾滋病毒治疗和预防方面取得了显著进展，但美国关键人群中的艾滋病毒发病率尚未大幅下降。2019年启动的联邦“终结艾滋病毒流行”（EHE）倡议旨在到2030年将艾滋病毒感染减少90%，重点关注四大支柱：快速诊断、早期开始抗逆转录病毒治疗（ART）、扩大预防（暴露前预防[PrEP]）和对疫情的快速反应。前三个支柱实施的数学模型表明，虽然可以实现艾滋病毒发病率的大幅下降，但在许多司法管辖区，实现EHE目标可能很困难。由于这一流行病在不同人口群体和地区的异质性，不存在“一刀切”的战略组合。因此，规划针对持续传播的干预措施需要详细了解当地流行病学。美国的艾滋病毒流行是由在时间和空间上重叠的亚流行病组成的，是由生物和社会因素共同形成的。最终，性和/或注射吸毒（IDU）行为在HIV病毒血症网络中的交叉导致HIV持续传播。总体而言，美国近36%的PWH没有受到病毒抑制，并且在艾滋病毒护理连续体上存在显著差异，这种差异在地理区域，种族/民族群体和性性别少数群体之间持续存在。由于美国阿片类药物流行的激增，艾滋病毒进入IDU网络的情况在过去十年中有所增加，导致了几次爆炸性的艾滋病毒爆发。因此，一些监测系统被用于检测艾滋病毒快速传播的地理区域[5,6]。在许多地区，新的艾滋病毒感染可能不是由爆炸性聚集性暴发引起的，但在公共卫生监测和应对活动中仍应发挥重要作用。
While remarkable progress has been achieved in HIV treatment and prevention over the past decade through widespread access to and use of antiretrovirals, HIV incidence has yet to substantially decline among key population in the United States (US). The federal Ending the HIV Epidemic (EHE) initiative launched in 2019 aims to reduce HIV infections by 90% by 2030 through focusing on four pillars: rapid diagnosis, early antiretroviral treatment (ART) initiation, expanded prevention (pre-exposure prophylaxis [PrEP]), and rapid response to outbreaks [1]. Mathematical modeling of the implementation of the first three pillars suggests that while substantial reductions in HIV incidence can be achieved, reaching EHE targets may be difficult in many jurisdictions [2]. There is no ‘one-size fits all’combination of strategies because of the heterogeneity of the epidemic across population groups and geography.Planning interventions directed toward ongoing transmission thus requires a detailed understanding of the local epidemiology. The US HIV epidemic is comprised of sub-epidemics that overlap in time and space, formed by a confluence of biological as well as social factors. Ultimately, the intersection of sexual and/or injection drug use (IDU) behaviors in networks with HIV viremia leads to ongoing HIV transmission. Overall, nearly 36% of PWH in the US are not virally suppressed, and there are significant disparities along the HIV care continuum that persist by geographic region, between racial/ethnic groups, and sexual gender minority groups [3]. The entry of HIV into IDU networks, which have increased over the past decade due to the surge in the US opioid epidemic, has led to several explosive HIV outbreaks [4]. Consequently, several monitoring systems are employed to detect geographic areas with rapid HIV transmissions [5, 6]. In many areas, new HIV infections may not arise from explosive cluster outbreaks [7] yet should remain important in public health monitoring and response activities.