Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model-based analysis to inform paediatric HIV screening programmes.
Prevalence of undiagnosed HIV among children in South Africa, Côte d'Ivoire and Zimbabwe: a model-based analysis to inform paediatric HIV screening programmes.
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DOI：
10.1002/jia2.26045
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发表时间：
2022-12
影响因子：
6
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中科院分区：
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为了改善艾滋病毒感染儿童的诊断和生存，世界卫生组织建议采用传统婴儿艾滋病毒检测方案以外的检测方法。需要关于普通人群中不同年龄儿童未确诊艾滋病毒流行率的信息，以指导创新的国家/国家以下各级病例发现和检测方法。我们使用预防艾滋病并发症的成本效益（CEPAC）-儿科模型来估计2018年南非，科特迪瓦和津巴布韦2岁，5岁和10岁儿童中未确诊的艾滋病毒的患病率。我们模拟了2008年（10奥尔兹），2013年（5奥尔兹）和2016年（2奥尔兹）出生的儿童队列。针对具体国家/年份的孕妇/哺乳期妇女的投入包括：艾滋病毒流行率（4.2-32.3%）、艾滋病毒发病率（0.03-0.24%/月）、艾滋病毒状况知识（27-89%）和抗逆转录病毒药物覆盖率（36-95%）。儿科投入包括早期婴儿检测覆盖率（6-95%）和母乳喂养持续时间（0-20个月）。我们预测了存活的CLWH中艾滋病毒仍然未被诊断的比例，以及总人口中每个年龄段存活儿童中未被诊断的艾滋病毒流行率。对于2016年出生的儿童，我们预测到2026年所有CLWH的生存和诊断。我们对模型参数进行了敏感性分析。2018年，在南非/科特迪瓦/津巴布韦，2岁CLWH中艾滋病毒未确诊的存活CLWH的预计比例为44.2%/55.8%/52.9%; 5岁CLWH中为29.0%/37.8%/33.2%; 10岁CLWH中为18.3%/25.4%/23.1%。在南非/科特迪瓦/津巴布韦，2岁奥尔兹中未确诊的艾滋病毒感染率预计为0.44%/0.32%/0.68%; 5岁奥尔兹为0.25%/0.17%/0.41%; 10岁奥尔兹为0.24%/0.14%/0.38%。在2016年出生的所有CLWH中，预计50-54%在出生后10年内没有艾滋病毒诊断（随后没有治疗）而死亡;这些死亡中的80-85%发生在前2年。预计人口一级未确诊的艾滋病毒流行率很低，2岁后急剧下降，CLWH死亡人数多于确诊人数。尽管年龄较大的儿童的一般人群中未确诊的患病率较低，我们的项目，CLWH的很大一部分仍然未确诊，这表明针对未经测试的所有年龄段的儿童卫生设施设置以外的创新战略应优先考虑。方案可以考虑对所有环境中的2岁以下儿童和高流行环境中的所有年龄段的儿童进行常规检测。
To improve the diagnosis and survival of children living with HIV (CLWH), the World Health Organization recommends testing approaches beyond traditional infant HIV testing programmes. Information about undiagnosed HIV prevalence among children of varying ages in the general population is needed to guide innovative national/subnational case‐finding and testing approaches. We used the Cost‐Effectiveness of Preventing AIDS Complications (CEPAC)‐Pediatric model to estimate the prevalence of undiagnosed HIV in 2‐, 5‐ and 10‐year‐old children in South Africa, Côte d'Ivoire and Zimbabwe in 2018. We simulated cohorts of children born in 2008 (10‐year‐olds), 2013 (5‐year‐olds) and 2016 (2‐year‐olds). Country‐/year‐specific inputs for pregnant/breastfeeding women included: HIV prevalence (4.2–32.3%), HIV incidence (0.03–0.24%/month), knowledge of HIV status (27–89%) and antiretroviral drug coverage (36–95%). Paediatric inputs included early infant testing coverage (6–95%) and breastfeeding duration (0–20 months). We projected the proportion of surviving CLWH in whom HIV remained undiagnosed and the undiagnosed HIV prevalence among surviving children of each age in the general population. For children born in 2016, we projected survival and diagnosis of all CLWH through 2026. We conducted sensitivity analyses on model parameters. In 2018, the projected proportion of surviving CLWH whose HIV remained undiagnosed in South Africa/Côte d'Ivoire/Zimbabwe was 44.2%/55.8%/52.9% among 2‐year‐old CLWH; 29.0%/37.8%/33.2% among 5‐year‐old CLWH; and 18.3%/25.4%/23.1% among 10‐year‐old CLWH. Projected general population undiagnosed HIV prevalence in South Africa/Côte d'Ivoire/Zimbabwe was 0.44%/0.32%/0.68% among 2‐year‐olds; 0.25%/0.17%/0.41% among 5‐year‐olds; and 0.24%/0.14%/0.38% among 10‐year‐olds. Among all CLWH born in 2016, 50–54% were projected to die without HIV diagnosis (and subsequently without treatment) within 10 years after birth; 80–85% of these deaths occurred in the first 2 years. Projected population‐level undiagnosed HIV prevalence is low and sharply decreases after age 2, with more CLWH dying than being diagnosed. Despite low undiagnosed prevalence in the general population of older children, we project that a large proportion of CLWH remain undiagnosed, suggesting that innovative strategies targeting untested children of all ages outside of health facility settings should be prioritized. Programmes could consider routine testing of the general population of children below 2 in all settings and children of all ages in high‐prevalence settings.
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DOI：
10.1097/inf.0000000000002680
发表时间：
2020-09
期刊：
The Pediatric infectious disease journal
影响因子：
--
作者：
Johnson LF;Patrick M;Stephen C;Patten G;Dorrington RE;Maskew M;Jamieson L;Davies MA
通讯作者：
Davies MA
影响因子：
3.7
作者：
Awopegba OE;Kalu A;Ahinkorah BO;Seidu AA;Ajayi AI
通讯作者：
Ajayi AI
影响因子：
6
作者：
Kiyaga, Charles;Urick, Brittany;Vojnov, Lara
通讯作者：
Vojnov, Lara
影响因子：
3.7
作者：
Nelson AK;Cassidy T;Trivino Duran L;Cox V;Wedderburn CJ;Giddy J;Pieters P;Cotton MF;Mutseyekwa T;Rorwana B;Sibanda B;Bernheimer J;Matise N;Isaakidis P;Maritz J
通讯作者：
Maritz J
影响因子：
6
作者：
Dunning L;Gandhi AR;Penazzato M;Soeteman DI;Revill P;Frank S;Phillips A;Dugdale C;Abrams E;Weinstein MC;Newell ML;Collins IJ;Doherty M;Vojnov L;Fassinou Ekouévi P;Myer L;Mushavi A;Freedberg KA;Ciaranello AL
通讯作者：
Ciaranello AL