HIV Prevention Efforts and Incidence of HIV in Uganda.
HIV Prevention Efforts and Incidence of HIV in Uganda.
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DOI：
10.1056/nejmoa1702150
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发表时间：
2017-11-30
期刊：
影响因子：
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通讯作者：
Rakai Health Sciences Program
中科院分区：
文献类型：
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作者：
Grabowski MK;Serwadda DM;Gray RH;Nakigozi G;Kigozi G;Kagaayi J;Ssekubugu R;Nalugoda F;Lessler J;Lutalo T;Galiwango RM;Makumbi F;Kong X;Kabatesi D;Alamo ST;Wiersma S;Sewankambo NK;Tobian AAR;Laeyendecker O;Quinn TC;Reynolds SJ;Wawer MJ;Chang LW;Rakai Health Sciences Program
为了评估艾滋病联合预防（CHP）对艾滋病发病率的影响，我们分析了艾滋病发病率与乌干达Rakai抗逆转录病毒治疗（ART）和医疗男性包皮环切术规模扩大之间的关系。还检查了人群水平病毒载量抑制和性行为的变化。在1999年至2016年期间，通过Rakai社区队列研究中30个社区的12项调查收集了数据，这是一个开放的基于人口的15-49岁人群队列。我们根据观察到的血清转换数据、自我报告的ART和男性包皮环切术覆盖率、病毒载量抑制和性行为评估了HIV发病率趋势。总共有33，937名研究参与者提供了103，011次访问（艾滋病毒流行率约为13%）。对17 870名艾滋病毒阴性者进行的后续行动贡献了94 427人年，其中931人血清转化。抗逆转录病毒疗法于2004年引入;到2016年，覆盖率为69%（女性72%，男性61%，p<0.001）。所有艾滋病毒阳性者的艾滋病毒载量抑制率从2009年的42%上升到2016年的75%（p<0.001）。男性包皮环切覆盖率从1999年的15%上升到2016年的59%（p<0.001）。15-19岁的人报告n71曾经有过性行为从30%增加到55%（p<0.0001）。与2010年之前的CHP前相比，2016年的艾滋病毒发病率下降了42%（1.17/100 py至0.66/100 py; adjIRR：0.58：95%CI：0.45-0.76）;男性的下降幅度（adjIRR=0.46; 95%CI：0.29-0.73）大于女性（adjIRR=0.68，95%CI：0.50-0.94）。在这项纵向研究中，随着卫生防护中心规模的扩大，艾滋病毒的发病率显著下降，这为艾滋病毒控制干预措施可以产生重大的人口影响提供了经验证据。然而，还需要作出更多努力，克服性别差距，实现消除艾滋病毒。
To assess the impact of combination HIV prevention (CHP) on HIV incidence, we analyzed the association between HIV incidence and scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral load suppression and sexual behaviors were also examined. Between 1999 and 2016, data were collected through 12 surveys from 30 communities in the Rakai Community Cohort Study, an open population-based cohort of persons aged 15-49 years. We assessed HIV incidence trends based on observed seroconversion data, self-reported ART and male circumcision coverage, viral load suppression, and sexual behaviors. In total, 33,937 study participants contributed 103,011 person-visits (HIV prevalence ~13%). Follow-up of 17,870 HIV-negative persons contributed 94,427 person-years with 931 seroconversions. ART was introduced in 2004; by 2016 coverage was 69% (72% in women vs. 61% in men, p<0.001). HIV viral load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (p<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (p<0.001). Persons 15-19 years reporting n 71 ever having sex increased from 30% to 55% (p<0.0001). HIV incidence declined by 42% in 2016 relative to the pre-CHP period prior to 2010 (1.17/100 py to 0.66/100 py; adjIRR:0.58: 95%CI: 0.45-0.76); declines were greater in men (adjIRR=0.46; 95%CI: 0.29-0.73) than women (adjIRR=0.68, 95%CI: 0.50-0.94). In this longitudinal study, HIV incidence significantly declined with CHP scale-up, providing empiric evidence that HIV control interventions can have substantial population-level impact. However, additional efforts are needed to overcome gender disparities and achieve HIV elimination.