Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades.
Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades.
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DOI：
10.1136/bmjgh-2015-000010
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发表时间：
2016
影响因子：
8.1
通讯作者：
Hill A
中科院分区：
文献类型：
--
作者：
Levi J;Raymond A;Pozniak A;Vernazza P;Kohler P;Hill A
2014年，联合国艾滋病规划署（UNAIDS）及其合作伙伴制定了“90-90-90目标”；目标是到2020年对所有艾滋病毒阳性者的90%进行诊断，为90%的确诊者提供抗逆转录病毒治疗，并使90%的接受治疗者实现病毒抑制。这导致81%的艾滋病毒阳性患者接受治疗，73%的艾滋病毒阳性患者实现病毒抑制。我们的目的是分析国家艾滋病毒治疗方案在使用艾滋病毒护理连续体或级联体实现这些目标方面的有效性。我们在已发表的论文、会议报告、联合国艾滋病规划署数据库和国家报告中搜索了196个国家的艾滋病治疗级联。级联是使用可靠的、可推广的、来自国家、横断面和纵向研究队列的最新数据构建的。数据收集分为四个阶段；经诊断、接受治疗和病毒抑制的艾滋病毒阳性者总数。级联被分为完整（4级）或部分（3级），并分析了“断点”，定义为在连续90-90-90目标之间的覆盖范围下降100 - 10%。分析了69个国家级联（32个完整，37个部分）。诊断率（目标1 - 90%）从87%（荷兰）到11%（也门）不等。治疗覆盖率（抗逆转录病毒治疗目标2 - 81%）从71%（瑞士）到3%（阿富汗）不等。病毒抑制率（目标3 - 73%）在68%（瑞士）和7%（中国）之间。所分析的国家中没有一个达到“90-90-90”目标。诊断是全球最大的转折点，但个别国家最常见的关键转折点是向确诊患者提供抗逆转录病毒治疗。各国之间存在巨大差异。没有对标准化报告方法的承诺，国际比较是复杂的。
In 2014, the Joint United Nations Programme on HIV and AIDS (UNAIDS) and partners set the ‘90-90-90 targets’; aiming to diagnose 90% of all HIV positive people, provide antiretroviral therapy (ART) for 90% of those diagnosed and achieve viral suppression for 90% of those treated, by 2020. This results in 81% of all HIV positive people on treatment and 73% of all HIV positive people achieving viral suppression. We aimed to analyse how effective national HIV treatment programmes are at meeting these targets, using HIV care continuums or cascades. We searched for HIV treatment cascades for 196 countries in published papers, conference presentations, UNAIDS databases and national reports. Cascades were constructed using reliable, generalisable, recent data from national, cross-sectional and longitudinal study cohorts. Data were collected for four stages; total HIV positive people, diagnosed, on treatment and virally suppressed. The cascades were categorised as complete (four stages) or partial (3 stages), and analysed for ‘break points’ defined as a drop >10% in coverage between consecutive 90-90-90 targets. 69 country cascades were analysed (32 complete, 37 partial). Diagnosis (target one—90%) ranged from 87% (the Netherlands) to 11% (Yemen). Treatment coverage (target two—81% on ART) ranged from 71% (Switzerland) to 3% (Afghanistan). Viral suppression (target three—73% virally suppressed) was between 68% (Switzerland) and 7% (China). No country analysed met the 90-90-90 targets. Diagnosis was the greatest break point globally, but the most frequent key break point for individual countries was providing ART to those diagnosed. Large disparities were identified between countries. Without commitment to standardised reporting methodologies, international comparisons are complex.