Scale-up of Early Infant HIV Diagnosis and Improving Access to Pediatric HIV Care in Global Plan Countries: Past and Future Perspectives
Scale-up of Early Infant HIV Diagnosis and Improving Access to Pediatric HIV Care in Global Plan Countries: Past and Future Perspectives
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DOI：
10.1097/qai.0000000000001319
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发表时间：
2017-05-01
影响因子：
3.6
通讯作者：
Peter, Trevor
中科院分区：
文献类型：
--
作者：
Essajee, Shaffiq;Bhairavabhotla, Ravikiran;Peter, Trevor
过去十年，对扩大艾滋病毒婴儿早期诊断 (EID) 的投资大幅增加。这项投资包括实体基础设施、设备、人力资源和标本运输系统以及向诊所提供实验室结果的专门机制。 《到 2015 年消除儿童新发艾滋病毒感染并保持母亲存活的全球计划》以及旨在预防艾滋病毒母婴传播和治疗感染艾滋病毒儿童的相关国际举措，通过调动资源、开展宣传、制定规范性建议以及通过国际利益攸关方全球社区向各国提供直接技术支持，成为这一扩大规模的重要驱动力。因此，2005 年至 2015 年间，每年进行的婴儿早期诊断检测数量增加了 10 倍，而且由于可及性的改善，成千上万的婴儿现在正在接受挽救生命的抗逆转录病毒治疗。尽管做出了这些努力并取得了许多成功案例，但及时的婴儿诊断在许多全球计划国家仍然是一个挑战。最新数据（2015 年底）表明访问量存在很大差异。一些国家报告称，几乎 90% 的艾滋病毒暴露婴儿正在接受检测；另一些人报告说，访问水平停滞在 30%。尽管如此，全球计划国家中超过一半的暴露婴儿在出生后的头两个月接受了检测。我们讨论了导致诊断能力扩大的关键因素，强调了阻碍进展的一些挑战，并描述了未来的优先事项，以帮助保持实现真正普遍获得儿童艾滋病毒检测的势头。
Investment to scale-up early infant diagnosis (EID) of HIV has increased substantially in the last decade. This investment includes physical infrastructure, equipment, human resources, and specimen transportation systems as well as specialized mechanisms to deliver laboratory results to clinics. The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive, as well as related international initiatives to prevent mother-to-child transmission of HIV and treat children living with HIV have been important drivers of this scale-up by mobilizing resources, creating advocacy, developing normative recommendations, and providing direct technical support to countries through the global community of international stake-holders. As a result, the number of early infant diagnosis tests performed annually has increased 10-fold between 2005 and 2015, and many thousands of infants are now receiving life-saving antiretroviral therapy because of this improved access. Despite these efforts and many success stories, timely infant diagnosis remains a challenge in many Global Plan countries. The most recent data (from the end of 2015) suggest a large variation in access. Some countries report that almost 90% of HIV-exposed infants are being tested; others report that the level of access has stagnated at 30%. Still, just over half of all exposed infants in Global Plan countries receive a test in the first 2 months of life. We discuss the key factors that are responsible for this scale-up of diagnostic capacity, highlight some of the challenges that have hampered progress, and describe priorities for the future that can help maintain momentum to achieve true universal access to HIV testing for children.