Improving ART programme retention and viral suppression are key to maximising impact of treatment as prevention - a modelling study.
Improving ART programme retention and viral suppression are key to maximising impact of treatment as prevention - a modelling study.
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DOI：
10.1186/s12879-017-2664-6
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发表时间：
2017-08-09
影响因子：
3.7
通讯作者：
White RG
中科院分区：
文献类型：
--
作者：
McCreesh N;Andrianakis I;Nsubuga RN;Strong M;Vernon I;McKinley TJ;Oakley JE;Goldstein M;Hayes R;White RG
联合国艾滋病规划署呼吁，到2020年，每年新增艾滋病毒感染人数少于50万，以治疗为预防是其实现这一目标战略的关键部分。更好地了解在护理途径的不同阶段对传播的贡献，可以帮助将干预服务集中在可能产生最大效果的人群中。我们以乌干达为案例进行研究。使用历史匹配拟合基于个体的HIV/ART模型。100个模型拟合产生的不确定性的性行为，艾滋病毒流行病学，和ART覆盖率到2015年在乌干达。在2016年至2030年期间，模拟了一些不同的ART规模扩大干预情景。计算了原发感染者、原发后ART初治感染者以及目前或以前接受ART治疗者随时间推移的传播发生率和比例。在所有情况下，ART初治人群的传播比例都有所下降，从2015年的70%（61%-79%）降至2030年的23%（15%-40%）至47%（35%-61%）。接受抗逆转录病毒疗法的人传播艾滋病毒的比例从7.8%（3.5%-13%）增加到14%（7.0%-24%）至38%（21%-55%）。因停止抗逆转录病毒疗法而传播的比例从22%（15%-33%）增加到31%（23%-43%）和56%（43%-70%）之间。随着乌干达抗逆转录病毒治疗覆盖率的增加，目前或以前接受抗逆转录病毒治疗的人可能在传播中发挥越来越大的作用。提高抗逆转录病毒治疗的保留率，确保抗逆转录病毒治疗的人保持病毒抑制，将是降低乌干达艾滋病毒发病率的关键。
UNAIDS calls for fewer than 500,000 new HIV infections/year by 2020, with treatment-as-prevention being a key part of their strategy for achieving the target. A better understanding of the contribution to transmission of people at different stages of the care pathway can help focus intervention services at populations where they may have the greatest effect. We investigate this using Uganda as a case study. An individual-based HIV/ART model was fitted using history matching. 100 model fits were generated to account for uncertainties in sexual behaviour, HIV epidemiology, and ART coverage up to 2015 in Uganda. A number of different ART scale-up intervention scenarios were simulated between 2016 and 2030. The incidence and proportion of transmission over time from people with primary infection, post-primary ART-naïve infection, and people currently or previously on ART was calculated. In all scenarios, the proportion of transmission by ART-naïve people decreases, from 70% (61%–79%) in 2015 to between 23% (15%–40%) and 47% (35%–61%) in 2030. The proportion of transmission by people on ART increases from 7.8% (3.5%–13%) to between 14% (7.0%–24%) and 38% (21%–55%). The proportion of transmission by ART dropouts increases from 22% (15%–33%) to between 31% (23%–43%) and 56% (43%–70%). People who are currently or previously on ART are likely to play an increasingly large role in transmission as ART coverage increases in Uganda. Improving retention on ART, and ensuring that people on ART remain virally suppressed, will be key in reducing HIV incidence in Uganda.
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影响因子：
4.1
作者：
Miller WC;Rosenberg NE;Rutstein SE;Powers KA
通讯作者：
Powers KA
影响因子：
4.3
作者：
Andrianakis I;Vernon IR;McCreesh N;McKinley TJ;Oakley JE;Nsubuga RN;Goldstein M;White RG
通讯作者：
White RG
影响因子：
5.4
作者：
NICOLOSI, A;LEITE, MLC;ZERBONI, R
通讯作者：
ZERBONI, R
影响因子：
11.8
作者：
Marzel, Alex;Shilaih, Mohaned;Kouyos, Roger D.
通讯作者：
Kouyos, Roger D.
影响因子：
39
作者：
Skarbinski, Jacek;Rosenberg, Eli;Mermin, Jonathan H.
通讯作者：
Mermin, Jonathan H.