Highlighting the need for investment and innovation in ART retention interventions.
Highlighting the need for investment and innovation in ART retention interventions.
复制标题
强调 ART 保留干预措施的投资和创新的必要性。
DOI：
10.1016/s2214-109x(22)00327-8
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Humphrey,Lia
中科院分区：
文献类型：
--
作者：
Nosyk,Bohdan;Humphrey,Lia
在《柳叶刀全球健康》杂志中，安娜·伯什廷及其同事1强调了全球艾滋病毒/艾滋病应对中日益突出的一个问题。在他们的综合分析中，作者使用了来自南非，马拉维和撒哈拉以南非洲的三个艾滋病毒模型的数据，以估计抗逆转录病毒治疗（ART）保留率的改善如何影响传播，健康和干预措施的上限成本。脱离抗逆转录病毒疗法的个人导致与艾滋病毒有关的死亡和传播比例不断上升。这在流行病应对最先进的环境中最为明显-例如，我们发现，尽管纽约市是城市环境中艾滋病毒控制的领导者，但在美国各地中断抗逆转录病毒治疗的个人造成的传播在纽约（NY，USA）最大。在获得治疗和预防干预措施方面的持续改善，只会使人们更加需要在今后几年中改进维持抗逆转录病毒疗法的战略。不幸的是，抗逆转录病毒疗法持续性方面的挑战普遍存在，即使在经济障碍较低的环境中也是如此，3而持续性差通常与社会和结构条件有关，这些条件导致最高风险人群的发病率。4这些因素进一步加剧了不平等现象，并可能扼杀抗逆转录病毒药物在人口一级的益处。5不幸的是，为应对这些挑战而采取的干预措施效果不佳，3成本相对较高，因而边际价值降低。
In The Lancet Global Health, Anna Bershteyn and colleagues1 highlight an issue of growing prominence in the global HIV/AIDS response. In their combined analysis, the authors used data from three HIV models set in South Africa, Malawi, and sub-Saharan Africa to estimate how improvement in retention on antiretroviral therapy (ART) could affect transmission, health, and upper-bound costs of interventions. Individuals disengaged from ART contribute to an increasing proportion of HIV-associated deaths and transmissions. This is most evident in settings with the most advanced epidemic responses—eg, we found that transmission attributable to individuals who discontinued ART across the USA was greatest in New York (NY, USA), 2 despite the city being a leader in HIV control in urban settings. Continued improvements in access to treatment and prevention interventions will only amplify the need to improve strategies in sustaining ART retention in the years to come. Challenges in ART persistence are unfortunately pervasive, even in settings with low financial barriers, 3 and poor persistence is typically tied to social and structural conditions that drive incidence in populations at greatest risk. 4 These factors further exacerbate inequities and might stifle the population-level benefits of ART. 5 Unfortunately, interventions to address these challenges have had only moderate effectiveness, 3 relatively high cost, and, subsequently, reduced marginal value.