HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences
HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences
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DOI：
10.1016/s0140-6736(04)16587-2
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发表时间：
2004-07-03
期刊：
影响因子：
168.9
通讯作者：
Boerma, JT
中科院分区：
文献类型：
--
作者：
Asamoah-Odei, E;Calleja, JMG;Boerma, JT
在撒哈拉以南非洲，艾滋病毒监测系统的扩大正在导致艾滋病流行规模的下调。然而，只有对同一人群长期监测数据进行分析，才能深入了解艾滋病毒流行趋势。我们使用的数据，从相同的产前诊所记录最近的经验trends.Methods我们整理数据，从产前诊所的艾滋病毒流行率在1997年和2003年之间。数据来自撒哈拉以南非洲22个国家300多个产前诊所的14万名孕妇。此外，长期趋势数据可用于57个城市地区和provinces.Findings中位艾滋病毒感染率在148产前诊所网站在南部非洲从21.3%（IQR 11.5-28.2%），1997/98年增加到23.8%（15.6-29.2%），在2002年。在一半以上的地点（58%），至少增加了十分之一，但在五分之一的地点，患病率下降了至少十分之一。在东非，艾滋病毒感染率中位数从1997/1998年的12.9%（7.0-16.9%）下降到2002年的8.5%（5.3-13.0%），有4个地点的感染率上升（7%），但有25个地点的感染率下降（43%）。在西非，1997/1998年和2002年的艾滋病毒感染率中位数分别为3.5%（2.2-5.9%）和3.2%（2.3-6.1%），感染率的下降和上升比例相同。撒哈拉以南非洲城市地区的长期趋势显示出类似的模式，越来越多的证据表明，在过去的2-3年中稳定与前decade.Interpretation证据，主要是城市产前诊所参加者的监测表明，在撒哈拉以南非洲艾滋病流行的增长已经趋于平稳，自20世纪90年代末，但只有东非显示艾滋病毒流行率下降。各次区域之间仍然存在很大的差异。计划对艾滋病流行病作出反应的工作人员必须更仔细地考虑这些差异，以便对这一流行病作出适合当地情况的反应。
Background Expansion of HIV surveillance systems in sub-Saharan Africa is leading to downward adjustments to the size of the AIDS epidemic. However, only analysis of surveillance data from the same populations over time can provide insight into trends of HIV prevalence. We have used data from the same antenatal clinics to document recent empirical trends.Methods We collated data from antenatal clinics on HIV prevalence between 1997 and 2003. Data were obtained from 140 000 pregnant women attending more than 300 antenatal clinics in 22 countries in sub-Saharan Africa. Additionally, long-term trend data are available for 57 urban areas and provinces.Findings Median HIV prevalence in 148 antenatal clinic sites in southern Africa increased from 21.3% (IQR 11.5-28.2%) in 1997/98 to 23.8% (15.6-29.2%) in 2002. At more than half the sites (58%) an increase of at least one-tenth was noted, but at a fifth of sites, prevalence dropped by at least one-tenth. In eastern Africa, median HIV prevalence decreased from 12.9% (7.0-16.9%) in 1997/98 to 8.5% (5.3-13.0%) in 2002, with prevalence rising in four (7%) sites, but falling at 25 (43%) sites. In west Africa, median HIV prevalence was 3.5% (2.2-5.9%) and 3.2% (2.3-6.1%) for 1997/98 and 2002, respectively, with reductions and increases in prevalence being noted in equal proportions. The long-term trends in urban areas in sub-Saharan Africa show a similar pattern, with increasing evidence of stabilisation during the past 2-3 years compared with the previous decade.Interpretation Evidence from surveillance of mostly urban antenatal clinic attendees indicates that the growth in the AIDS epidemic in sub-Saharan Africa has levelled off since the late 1990s but only eastern Africa shows a decline in HIV prevalence. Very large differences persist between subregions. Workers planning a response to the AIDS epidemic must take more careful consideration of these variations to allow locally appropriate responses to the epidemic.