Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models
Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models
复制标题
DOI：
10.1016/s2352-3018(20)30211-3
复制
发表时间：
2020-09-01
期刊：
影响因子：
16.1
通讯作者：
Kelly, Sherrie L.
中科院分区：
文献类型：
--
作者：
Jewell, Britta L.;Mudimu, Edinah;Kelly, Sherrie L.
背景
新冠大流行可能会导致撒哈拉以南非洲地区为艾滋病病毒感染者以及有感染艾滋病病毒风险的人群提供的艾滋病相关服务中断。据联合国艾滋病规划署估计，2018年约3800万艾滋病病毒感染者中有超过三分之二居住在该地区。我们旨在预测此类中断对撒哈拉以南非洲地区艾滋病相关死亡和新增感染的潜在影响。
方法
在这项建模研究中，我们使用了五个描述详细的艾滋病流行模型（Goals、Optima HIV、HIV Synthesis、伦敦帝国理工学院模型以及流行病学建模软件[EMOD]）来估计从2020年4月1日起，在1年内持续6个月的艾滋病预防、检测和治疗服务的各种潜在中断对撒哈拉以南非洲地区艾滋病相关死亡和新增感染的影响。我们考虑了中断影响20%、50%和100%人口的情况。
结果
在接受治疗的艾滋病病毒感染者中，50%的人群抗逆转录病毒治疗（ART）药物供应中断6个月，预计在1年内与无中断情况相比，艾滋病相关死亡将增加1.63倍（各模型的中位数；范围1.39 - 1.87）。在撒哈拉以南非洲地区，如果发生如此高程度的中断，根据所有模型估计，艾滋病死亡人数中位数将额外增加29.6万（范围229023 - 420000）。抗逆转录病毒治疗的中断会使艾滋病母婴传播增加约1.6倍。尽管抗逆转录病毒治疗药物供应中断在所有潜在中断情况中影响最大，但由于卫生设施过度紧张导致的临床护理质量下降、复方新诺明等其他药物供应中断以及艾滋病检测暂停等情况，都会对人群层面的死亡率产生重大影响（与无中断情况相比，由于中断影响50%的人口，1年内艾滋病相关死亡最多增加1.06倍）。避孕套供应中断和同伴教育中断会使人群更容易出现艾滋病发病率上升的情况，尽管保持社交距离措施可能会导致危险性行为减少（如果50%的人受到影响，1年内新增艾滋病感染最多增加1.19倍）。
解释
在新冠大流行期间，政府、捐助者、供应商和社区的首要任务应集中在为艾滋病病毒感染者维持抗逆转录病毒治疗药物的不间断供应，以避免额外的艾滋病相关死亡。提供其他艾滋病预防措施对于防止艾滋病发病率上升也很重要。版权所有(c) 2020世界卫生组织；爱思唯尔授权。
Background The COVID-19 pandemic could lead to disruptions to provision of HIV services for people living with HIV and those at risk of acquiring HIV in sub-Saharan Africa, where UNAIDS estimated that more than two-thirds of the approximately 38 million people living with HIV resided in 2018. We aimed to predict the potential effects of such disruptions on HIV-related deaths and new infections in sub-Saharan Africa.Methods In this modelling study, we used five well described models of HIV epidemics (Goals, Optima HIV, HIV Synthesis, an Imperial College London model, and Epidemiological MODeling software [EMOD]) to estimate the effect of various potential disruptions to HIV prevention, testing, and treatment services on HIV-related deaths and new infections in sub-Saharan Africa lasting 6 months over 1 year from April 1, 2020. We considered scenarios in which disruptions affected 20%, 50%, and 100% of the population.Findings A 6-month interruption of supply of antiretroviral therapy (ART) drugs across 50% of the population of people living with HIV who are on treatment would be expected to lead to a 1.63 times (median across models; range 1.39-1.87) increase in HIV-related deaths over a 1-year period compared with no disruption. In sub-Saharan Africa, this increase amounts to a median excess of HIV deaths, across all model estimates, of 296 000 (range 229023-420000) if such a high level of disruption occurred. Interruption of ART would increase mother-to-child transmission of HIV by approximately 1.6 times. Although an interruption in the supply of ART drugs would have the largest impact of any potential disruptions, effects of poorer clinical care due to overstretched health facilities, interruptions of supply of other drugs such as co-trimoxazole, and suspension of HIV testing would all have a substantial effect on population-level mortality (up to a 1.06 times increase in HIV-related deaths over a 1-year period due to disruptions affecting 50% of the population compared with no disruption). Interruption to condom supplies and peer education would make populations more susceptible to increases in HIV incidence, although physical distancing measures could lead to reductions in risky sexual behaviour (up to 1.19 times increase in new HIV infections over a 1-year period if 50% of people are affected).Interpretation During the COVID-19 pandemic, the primary priority for governments, donors, suppliers, and communities should focus on maintaining uninterrupted supply of ART drugs for people with HIV to avoid additional HIV-related deaths. The provision of other HIV prevention measures is also important to prevent any increase in HIV incidence. Copyright (c) 2020 World Health Organization; licensee Elsevier.