Integrating HIV prevention and treatment: from slogans to impact.
Integrating HIV prevention and treatment: from slogans to impact.
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DOI：
10.1371/journal.pmed.0020016
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发表时间：
2005-01
期刊：
影响因子：
15.8
通讯作者：
Schwartländer B
中科院分区：
文献类型：
--
作者：
Salomon JA;Hogan DR;Stover J;Stanecki KA;Walker N;Ghys PD;Schwartländer B
通过在全世界大力降低抗逆转录病毒疗法的费用和扩大其获得机会，现在即使在资源严重受限的情况下，也可以向艾滋病毒/艾滋病感染者广泛提供有效治疗。然而，在更广泛的艾滋病毒/艾滋病控制战略的背景下，治疗的潜在流行病学影响尚未得到研究。在本文中，我们量化了大规模治疗推广的机会和潜在风险。我们使用了一个艾滋病毒/艾滋病的流行病学模型，校准到撒哈拉以南非洲地区，调查一系列可能的积极和消极的健康结果下的替代方案，反映不同的预防和治疗的实施。在反映“一切照旧”的基线预测中，预计新感染人数和艾滋病死亡人数将继续上升。在代表以治疗为中心的战略的两种情景中，对治疗对传播性和行为的影响有不同的假设，到2020年新感染总数的变化范围从增加10%到减少6%，而到2020年艾滋病死亡人数下降9%到13%。到2020年，以预防为中心的战略可提供与以治疗为中心的方案相似的更大的发病率降低（36%）和死亡率降低，但在未来5至10年内死亡率获益更小。如果治疗能在综合应对中加强预防，预期效益将是巨大的-到2020年可避免2 900万例感染（55%）和1 000万例死亡（27%）。然而，如果狭隘地注重扩大治疗规模导致预防工作的有效性降低，那么综合应对措施的效益就小得多-避免900万例感染（17%）和避免600万例死亡（16%）。将治疗与有效的预防工作结合起来，从长远来看，可以大大减少治疗所需的资源。在各种设想方案中，2020年接受治疗的人数从920万人（仅治疗设想方案，效果好坏参半）到420万人（综合应对设想方案，治疗-预防产生积极协同作用）不等。这些分析表明，如果要长期减少新的艾滋病毒感染人数和大幅降低艾滋病死亡率，就必须将扩大的护理活动与预防活动结合起来。治疗可以促成更有效的预防，而预防则使治疗负担得起。只有采取全面对策，才能在全球防治艾滋病毒/艾滋病的斗争中取得持续进展。将预防和治疗艾滋病毒/艾滋病的两种方法结合起来，到2020年可以避免2900多万新的艾滋病毒感染
Through major efforts to reduce costs and expand access to antiretroviral therapy worldwide, widespread delivery of effective treatment to people living with HIV/AIDS is now conceivable even in severely resource-constrained settings. However, the potential epidemiologic impact of treatment in the context of a broader strategy for HIV/AIDS control has not yet been examined. In this paper, we quantify the opportunities and potential risks of large-scale treatment roll-out. We used an epidemiologic model of HIV/AIDS, calibrated to sub-Saharan Africa, to investigate a range of possible positive and negative health outcomes under alternative scenarios that reflect varying implementation of prevention and treatment. In baseline projections, reflecting “business as usual,” the numbers of new infections and AIDS deaths are expected to continue rising. In two scenarios representing treatment-centered strategies, with different assumptions about the impact of treatment on transmissibility and behavior, the change in the total number of new infections through 2020 ranges from a 10% increase to a 6% reduction, while the number of AIDS deaths through 2020 declines by 9% to 13%. A prevention-centered strategy provides greater reductions in incidence (36%) and mortality reductions similar to those of the treatment-centered scenarios by 2020, but more modest mortality benefits over the next 5 to 10 years. If treatment enhances prevention in a combined response, the expected benefits are substantial—29 million averted infections (55%) and 10 million averted deaths (27%) through the year 2020. However, if a narrow focus on treatment scale-up leads to reduced effectiveness of prevention efforts, the benefits of a combined response are considerably smaller—9 million averted infections (17%) and 6 million averted deaths (16%). Combining treatment with effective prevention efforts could reduce the resource needs for treatment dramatically in the long term. In the various scenarios the numbers of people being treated in 2020 ranges from 9.2 million in a treatment-only scenario with mixed effects, to 4.2 million in a combined response scenario with positive treatment–prevention synergies. These analyses demonstrate the importance of integrating expanded care activities with prevention activities if there are to be long-term reductions in the number of new HIV infections and significant declines in AIDS mortality. Treatment can enable more effective prevention, and prevention makes treatment affordable. Sustained progress in the global fight against HIV/AIDS will be attained only through a comprehensive response. Combining the two approaches of prevention and treatment of HIV/AIDS could avert more than 29 million new HIV infections by 2020
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影响因子：
3.8
作者：
Grémy, I;Beltzer, N
通讯作者：
Beltzer, N
影响因子：
3.8
作者：
Moatti, JP;Prudhomme, J;Msellati, P
通讯作者：
Msellati, P
影响因子：
56.9
作者：
Stoneburner, RL;Low-Beer, D
通讯作者：
Low-Beer, D
DOI：
10.1097/00126334-200308010-00010
发表时间：
2003-08-01
影响因子：
3.6
作者：
Wolf, K;Young, J;Bucher, HC
通讯作者：
Bucher, HC
DOI：
10.1097/00042560-199703010-00009
发表时间：
1997-03-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
Koopman, JS;Jacquez, JA;Lange, K
通讯作者：
Lange, K