Estimating the impact of the US President's Emergency Plan for AIDS Relief on HIV treatment and prevention programmes in Africa
Estimating the impact of the US President's Emergency Plan for AIDS Relief on HIV treatment and prevention programmes in Africa
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DOI：
10.1136/sextrans-2014-051991
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发表时间：
2015-12-01
影响因子：
3.6
通讯作者：
Mahy, Mary
中科院分区：
文献类型：
--
作者：
Heaton, Laura M.;Bouey, Paul D.;Mahy, Mary
背景自2004年以来，美国总统艾滋病紧急救援计划（PEPFAR）支持大幅扩大艾滋病毒预防、护理和治疗服务，主要是在撒哈拉以南非洲地区。我们评估了2004年至2013年在非洲16个PEPFAR国家中抗逆转录病毒治疗（ART）、预防母婴传播（PMTCT）和自愿医疗男性包皮环切术（VMMC）方案对存活率、死亡率、新感染和孤儿数量的影响。在16个总统艾滋病紧急救援计划国家收集了防止母婴传播的抗逆转录病毒疗法方案和通过VMMC进行的艾滋病毒生物医学预防。为了评估PEPFAR计划对ART，PMTCT和VMMC的影响，我们将PEPFAR支持的干预措施的当前情景与没有PEPFAR的反事实情景进行了比较，并评估了获得的生命年数（LYG），避免的孤儿人数和避免的艾滋病毒感染人数。结果从2004年到2013年，PEPFAR计划为16个PEPFAR国家的24 565 127名成人和儿童提供了抗逆转录病毒治疗，4 154 878名男性包皮环切术，4 154 478名孕妇接受了抗逆转录病毒治疗。根据该模型的结果，这些努力在同一时期帮助避免了290万艾滋病毒感染。在2004-2013年期间，仅PEPFAR ART项目就帮助16个PEPFAR国家避免了近900万孤儿，并产生了1160万LYG。2004- 2010年期间非洲的防止母婴传播方案和病毒、母婴传播和监测方案2013年，新的艾滋病毒感染者和孤儿大幅减少，艾滋病毒感染者的寿命延长。我们的估计数没有考虑到总统艾滋病紧急救援计划资助的非生物医学干预措施的影响，如总统艾滋病紧急救援计划国家采用的艾滋病毒预防、护理和治疗综合战略中所包括的行为和结构干预措施。因此，这些模型可能低估了艾滋病毒感染人数和避免的孤儿人数以及LYG。
Background Since 2004, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported the tremendous scale-up of HIV prevention, care and treatment services, primarily in sub-Saharan Africa. We evaluate the impact of antiretroviral treatment (ART), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC) programmes on survival, mortality, new infections and the number of orphans from 2004 to 2013 in 16 PEPFAR countries in Africa.Methods PEPFAR indicators tracking the number of persons receiving ART for their own health, ART regimens for PMTCT and biomedical prevention of HIV through VMMC were collected across 16 PEPFAR countries. To estimate the impact of PEPFAR programmes for ART, PMTCT and VMMC, we compared the current scenario of PEPFAR-supported interventions to a counterfactual scenario without PEPFAR, and assessed the number of life years gained (LYG), number of orphans averted and HIV infections averted. Mathematical modelling was conducted using the SPECTRUM modelling suite V.5.03.Results From 2004 to 2013, PEPFAR programmes provided support for a cumulative number of 24 565 127 adults and children on ART, 4 154 878 medical male circumcisions, and ART for PMTCT among 4 154 478 pregnant women in 16 PEPFAR countries. Based on findings from the model, these efforts have helped avert 2.9 million HIV infections in the same period. During 2004-2013, PEPFAR ART programmes alone helped avert almost 9 million orphans in 16 PEPFAR countries and resulted in 11.6 million LYG.Conclusions Modelling results suggest that the rapid scale-up of PEPFAR-funded ART, PMTCT and VMMC programmes in Africa during 2004-2013 led to substantially fewer new HIV infections and orphaned children during that time and longer lives among people living with HIV. Our estimates do not account for the impact of the PEPFAR-funded non-biomedical interventions such as behavioural and structural interventions included in the comprehensive HIV prevention, care and treatment strategy used by PEPFAR countries. Therefore, the number of HIV infections and orphans averted and LYG may be underestimated by these models.