Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm
Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm
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DOI：
10.2471/blt.08.059212
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发表时间：
2009-11-01
期刊：
影响因子：
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通讯作者：
Ndowa, Francis
中科院分区：
文献类型：
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作者：
Steen, Richard;Wi, Teodora Elvira;Ndowa, Francis
控制性传播感染（STI）是可行的，可以改善性健康和生殖健康，并有助于预防艾滋病毒传播。最严重的艾滋病毒流行是在性传播感染控制不佳的情况下发展的，特别是在溃疡性传播感染流行的地区。一些已成功控制性传播感染的国家已经记录了其艾滋病毒流行情况的稳定或逆转。性传播感染控制是一项通过降低发病率和流行率来衡量的公共卫生成果。实现这一目标的方法包括： (i) 针对风险最大的人群并进行外展活动； (ii) 推广和提供安全套及其他预防手段； (iii) 有效的临床干预措施； ㈣ 有利的环境； (v) 可靠的数据。临床服务包括性传播感染病例管理、性伴侣性传播感染筛查和管理。症状病例管理对于大多数有症状的可治愈性传播感染是有效的，并且存在筛查策略来检测一些无症状感染。对性伴侣和性工作者的推定流行病学治疗补充了阻断传播和降低流行率的努力。仅凭临床服务不足以控制疾病，因为许多性传播感染患者不去诊所就诊。外展和同伴教育已被有效地用于覆盖此类人群。性传播感染控制需要对核心人群进行有效干预，这些人群的性伙伴更换率足以维持传播。因此，有效、适当的目标是必要的，并且通常足以降低一般人群的患病率。这些努力与结构性干预措施相结合才能最有效，以确保为预防创造有利的环境。可靠的监测和相关数据对于设计和评估干预措施以及评估控制工作至关重要。
Control of sexually transmitted infections (STIs) is feasible, leads to improved sexual and reproductive health and contributes to preventing HIV transmission. The most advanced HIV epidemics have developed under conditions of poorSTI control, particularly where ulcerative STIs were prevalent. Several countries that have successfully controlled STIs have documented stabilization or reversal of their HIV epidemics. STI control is a public health outcome measured by reduced incidence and prevalence. The means to achieve this include: (i) targeting and outreach to populations at greatest risk; (ii) promoting and providing condoms and other means of prevention; (iii) effective clinical interventions; (iv) an enabling environment; and (v) reliable data.Clinical services include STI case management, screening and management of STIs in sex partners. Syndromic case management is effective for most symptomatic curable STIs and screening strategies exist to detect some asymptomatic infections. Presumptive epidemiologic treatment of sex partners and sex workers complement efforts to interrupt transmission and reduce prevalence. Clinical services alone are insufficient for control since many people with STIs do not attend clinics. Outreach and peer education have been effectively used to reach such populations.STI control requires effective interventions with core populations whose rates of partner change are high enough to sustain transmission. Effective, appropriate targeting is thus necessary and often sufficient to reduce prevalence in the general population. Such efforts are most effective when combined with structural interventions to ensure an enabling environment for prevention. Reliable surveillance and related data are critical for designing and evaluating interventions and for assessing control efforts.