The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study.
The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study.
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DOI：
10.1097/olq.0000000000001711
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发表时间：
2022-12-01
影响因子：
3.1
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中科院分区：
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艾滋病毒伙伴服务对人口一级艾滋病毒预防的影响估计很小，但在伙伴识别和向伙伴提供艾滋病毒筛查、抗逆转录病毒治疗和接触前预防方面没有实质性改善。艾滋病毒伙伴服务可以加速使用基于抗逆转录病毒的艾滋病毒预防工具（抗逆转录病毒治疗[ART]和暴露前预防[PrEP]），但其对长期艾滋病毒发病率降低的人口影响具有挑战性，难以用传统的伙伴服务指标确定或筛查艾滋病毒。要实现艾滋病毒预防目标，就必须了解伙伴服务在艾滋病毒预防干预措施组合中的作用，包括利用伙伴服务有效提供抗逆转录病毒药物。我们使用了一个随机网络模型的艾滋病毒/性传播感染传播的男性谁与男性发生性关系，校准到基于监测的估计在亚特兰大地区，一个管辖区的高艾滋病毒负担和次优的合作伙伴服务摄取。模型设想的情况各不相同，成功提供伙伴服务的级联步骤（新诊断的“索引”患者和伙伴的识别，伙伴艾滋病毒筛查，以及在PrEP或抗逆转录病毒治疗护理的合作伙伴的联系或重新参与）单独和联合。在亚特兰大观察到的目前水平，取消艾滋病毒伙伴服务对10年累计艾滋病毒发病率的影响微乎其微，改善单一伙伴服务步骤，同时保持其他步骤不变。这些变化并没有充分影响PrEP或ART的整体覆盖率，以减少艾滋病毒的传播。如果确定了所有指标患者和伴侣，最大限度地提高伴侣艾滋病毒筛查，伴侣PrEP提供，伴侣ART联系和伴侣ART重新参与将分别避免6%，11%，5%和18%的感染。在伴侣识别和服务提供方面的实际改进估计可以避免2%至8%的感染，这取决于改进的组合。实现最佳的艾滋病毒预防与合作伙伴的服务取决于配对改善索引患者和合作伙伴的识别与最大限度地提供艾滋病毒筛查，抗逆转录病毒治疗，并准备合作伙伴，如果有必要。改进识别步骤而不改进提供抗逆转录病毒服务的步骤，或反之亦然，预计对人口艾滋病毒预防的益处微乎其微。
HIV partner services has low estimated impact on population-level HIV prevention without substantial improvements to both partner identification and delivery of HIV screening, antiretroviral therapy, and preexposure prophylaxis to partners. HIV partner services can accelerate the use of antiretroviral-based HIV prevention tools (antiretroviral therapy [ART] and preexposure prophylaxis [PrEP]), but its population impact on long-term HIV incidence reduction is challenging to quantify with traditional partner services metrics of partner identified or HIV screened. Understanding the role of partner services within the portfolio of HIV prevention interventions, including using it to efficiently deliver antiretrovirals, is needed to achieve HIV prevention targets. We used a stochastic network model of HIV/sexually transmitted infection transmission for men who have sex with men, calibrated to surveillance-based estimates in the Atlanta area, a jurisdiction with high HIV burden and suboptimal partner services uptake. Model scenarios varied successful delivery of partner services cascade steps (newly diagnosed “index” patient and partner identification, partner HIV screening, and linkage or reengagement of partners in PrEP or ART care) individually and jointly. At current levels observed in Atlanta, removal of HIV partner services had minimal impact on 10-year cumulative HIV incidence, as did improving a single partner services step while holding the others constant. These changes did not sufficiently impact overall PrEP or ART coverage to reduce HIV transmission. If all index patients and partners were identified, maximizing partner HIV screening, partner PrEP provision, partner ART linkage, and partner ART reengagement would avert 6%, 11%, 5%, and 18% of infections, respectively. Realistic improvements in partner identification and service delivery were estimated to avert 2% to 8% of infections, depending on the combination of improvements. Achieving optimal HIV prevention with partner services depends on pairing improvements in index patient and partner identification with maximal delivery of HIV screening, ART, and PrEP to partners if indicated. Improving the identification steps without improvement to antiretroviral service delivery steps, or vice versa, is projected to result in negligible population HIV prevention benefit.