Modeling an integrated HIV prevention and care continuum to achieve the Ending the HIV Epidemic goals.
Modeling an integrated HIV prevention and care continuum to achieve the Ending the HIV Epidemic goals.
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建立一个综合艾滋病毒预防和护理连续体，以实现结束艾滋病毒流行的目标。
DOI：
10.1097/qad.0000000000002681
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发表时间：
2020-11-15
期刊：
影响因子：
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通讯作者：
Delaney KP
中科院分区：
文献类型：
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作者：
Jenness SM;Johnson JA;Hoover KW;Smith DK;Delaney KP
我们试图评估哪些艾滋病毒预防和护理活动的组合将对实现美国终止艾滋病毒流行（EHE）计划降低艾滋病毒发病率的目标产生最大影响。男男性行为者（MSM）的基于随机网络的HIV传播模型，根据EHE重点管辖区亚特兰大地区的监测估计进行校准。在不同的假设下，艾滋病毒阴性的男男性行为者如何与PrEP启动联系起来，以及艾滋病毒护理联系和保留率对那些筛查阳性的人来说，模型情景改变了艾滋病毒筛查率。艾滋病毒筛查率相对增加10倍（黑人和西班牙裔男男性行为者大约每半年筛查一次，白色男男性行为者每季度筛查一次），如果与PrEP启动相结合，将导致43%的感染避免。仅针对黑人男男性接触者的改进将实现几乎相同的结果（避免37%的感染）。如果保留率提高10倍，改善艾滋病毒护理保留将避免41%的感染。如果筛查和保留率共同提高10倍，高达74%的累积感染将被避免。在这种情况下，需要4年时间才能实现75%的EHE目标，需要12年时间才能实现亚特兰大MSM的90%目标。在目标日期之前实现EHE发病率降低75%的目标将需要立即大幅改善艾滋病毒筛查，PrEP和ART护理保留。只有满足黑人男男性行为者的艾滋病毒服务需求，才有可能在亚特兰大等目标管辖区实现这些EHE目标。
We sought to evaluate which combinations of HIV prevention and care activities would have the greatest impact towards reaching the US Ending the HIV Epidemic (EHE) plan goals of HIV incidence reduction. A stochastic network-based HIV transmission model for men who have sex with men (MSM), calibrated to surveillance estimates in the Atlanta area, a focal EHE jurisdiction. Model scenarios varied HIV screening rates under different assumptions of how HIV-negative MSM would be linked to PrEP initiation, and rates of HIV care linkage and retention for those screening positive. A 10-fold relative increase in HIV screening rates (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 43% of infections averted if integrated with PrEP initiation. Improvements focused only on black MSM would achieve nearly the same outcome (37% of infections averted). Improvements to HIV care retention would avert 41% of infections if retention rates were improved 10-fold. If both screening and retention were jointly improved 10-fold, up to 74% of cumulative infections would be averted. Under this scenario, it would take 4 years to meet the 75% EHE goal and 12 years to meet the 90% goal for Atlanta MSM. Reaching the EHE 75% incidence reduction goals by their target dates will require immediate and substantial improvements in HIV screening, PrEP, and ART care retention. Meeting these EHE goals in target jurisdictions like Atlanta will be possible only by addressing the HIV service needs of black MSM.