Towards ending HIV in Zimbabwe through focusing on improving targeting of HIV testing and uptake of HIV prevention in adolescent girls and young women

通过重点改善艾滋病毒检测的针对性以及少女和年轻妇女对艾滋病毒预防的了解，在津巴布韦消除艾滋病毒

• 批准号: MR/T042796/1
• 负责人: Valentina Cambiano
• 金额: $ 140.85万
• 依托单位: University College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT042796%2F1
• 关键词: Towards; ending; HIV; Zimbabwe; through

In Zimbabwe HIV remains the leading cause of death. In 2016, 1 in 7 adults were living with HIV. In order to end the HIV epidemic as a public health threat by 2030, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the targets of: (a) 95% of people living with HIV (PLWH) being diagnosed, (b) 95% of those diagnosed on antiretroviral therapy (ART), and (c) 95% of those on ART with an undetectable viral load ("suppressed"). These targets were based on the rationale that PLWH diagnosed, on ART and suppressed have near normal life-expectancy and cannot transmit the virus to others. In Zimbabwe in 2016 these were: (a) 73%, (b) 87% and (c) 86%, respectively, despite the number of HIV tests having increased by four-fold between 2007 and 2017. This is particularly low among adolescents and young people. In addition, the proportion of all HIV tests with a positive result has been declining, with a higher cost to identify each new case. For this reason, Zimbabwe is shifting to differentiated HIV testing strategies, targeting sub-populations at higher risk of HIV and using a range of testing strategies (e.g. "index testing", whereby household, family members or partners of people diagnosed with HIV are offered an HIV test; self-testing). However, the impact of this shift is unclear, as is whether it offers value for money.Adolescent girls and young women (AGYW; aged 15-24) are disproportionately affected by HIV. The World Health Organization (WHO) recommends Pre-Exposure Prophylaxis (PrEP; use of specific antiretrovirals in people without HIV to prevent HIV infection), as an additional choice for people at substantial risk of HIV (including AGYW). In Zimbabwe PrEP roll out has started, but only 4% of current users are AGYW (not counting those reporting as selling sex). An approach to increase PrEP use among those AGYW most at risk is required. Studies evaluating the safety and efficacy of additional PrEP formulations (long-acting injectables, implants, other antiretrovirals and in combination with contraceptives) are ongoing. However, little is known about preferences of AGYW for different PrEP attributes, nor is there information on how to ensure high uptake and sufficient support among this group.The overall aim of this fellowship is to fill these gaps. This will be achieved by: a. working closely with the Zimbabwe Ministry of Health and Child Care and other stakeholders to identify the optimal combination of HIV testing strategies that maximise health, within the budget available, to assess its impact (in terms of HIV infections, morbidity and mortality) and whether this combination is predicted to achieve the target of 95% of PLWH being diagnosed by 2030. This will be performed using a mathematical model informed by analysis of data already collected in Zimbabwe.b. co-developing with AGYW a PrEP implementation intervention for AGYW who need it, that attracts them to PrEP, and supports them while taking PrEP, with the potential to offer value for money. This will be achieved using qualitative and quantitative methods (survey of AGYW) and mathematical modelling.If the PrEP implementation intervention developed has the potential to offer value for money and being affordable, it will be then evaluated in a randomised trial in Years 5-7. The research will be led by Dr Valentina Cambiano, Lecturer in Infectious Disease Modelling and Biostatistics at University College London (UCL) and will draw together experts from UCL, the Liverpool School of Tropical Medicine and the Centre for Sexual Health and HIV/AIDS Research Zimbabwe and Zimbabwe and international policy makers. This research is required to address questions low- and middle- income countries with a high HIV burden are facing.

在津巴布韦，艾滋病毒仍然是导致死亡的主要原因。2016年，每7名成年人中就有1人感染艾滋病毒。为了到2030年结束艾滋病毒流行病对公共卫生的威胁，联合国艾滋病毒/艾滋病联合规划署（艾滋病规划署）设定了以下目标：（a）95%的艾滋病毒感染者（PLWH）得到诊断，（B）95%的被诊断者接受抗逆转录病毒治疗（ART），（c）95%的接受ART的人病毒载量检测不到（“抑制”）。这些目标的依据是，经诊断、接受抗逆转录病毒治疗和抑制的艾滋病毒携带者预期寿命接近正常，不会将病毒传染给他人。在津巴布韦，2016年的这三个数字分别为：（a）73%，（B）87%和（c）86%，尽管2007年至2017年间艾滋病毒检测数量增加了四倍。这在青少年和年轻人中尤其低。此外，所有艾滋病毒检测结果呈阳性的比例一直在下降，查明每个新病例的费用增加。为此，津巴布韦正在转向有区别的艾滋病毒检测战略，以艾滋病毒风险较高的亚群体为目标，并采用一系列检测战略（例如“指数检测”，即向被诊断为艾滋病毒感染者的家庭、家庭成员或伴侣提供艾滋病毒检测;自我检测）。然而，这一转变的影响尚不清楚，也不清楚它是否物有所值，少女和年轻妇女（15-24岁）感染艾滋病毒的比例过高。世界卫生组织（WHO）建议暴露前预防（PrEP;在没有艾滋病毒的人群中使用特定的抗逆转录病毒药物以预防艾滋病毒感染）作为艾滋病毒高风险人群（包括AGYW）的额外选择。在津巴布韦，PrEP的推广已经开始，但目前只有4%的用户是AGYW（不包括那些报告为性交易的人）。需要一种方法来增加那些AGYW风险最大的PrEP使用。评估其他PrEP制剂（长效注射剂，植入剂，其他抗逆转录病毒药物以及与避孕药联合使用）的安全性和有效性的研究正在进行中。然而，关于AGYW对不同PrEP属性的偏好知之甚少，也没有关于如何确保这一群体的高吸收和足够支持的信息。这将通过以下方式实现：a.与津巴布韦卫生和儿童保育部及其他利益攸关方密切合作，在现有预算范围内确定最佳的艾滋病毒检测战略组合，以最大限度地提高健康水平，评估其影响（在艾滋病毒感染、发病率和死亡率方面），以及这种组合是否有望实现到2030年诊断出95%的艾滋病毒携带者的目标。这将使用一个数学模型进行，该模型通过分析在津巴布韦已经收集的数据得到信息。与AGYW共同开发针对需要的AGYW的PrEP实施干预措施，吸引他们接受PrEP，并在服用PrEP时支持他们，并有可能提供物有所值。这将使用定性和定量方法（AGYW调查）和数学建模来实现。如果开发的PrEP实施干预措施具有提供物有所值和负担得起的潜力，则将在第5-7年的随机试验中进行评估。这项研究将由伦敦（UCL）传染病建模和生物统计学讲师Valentina Cambiano博士领导，并将汇集来自UCL，利物浦热带医学院和津巴布韦性健康和艾滋病毒/艾滋病研究中心的专家以及国际政策制定者。这项研究需要解决艾滋病毒负担高的低收入和中等收入国家所面临的问题。

项目成果

A quantitative assessment of the consistency of projections from five mathematical models of the HIV epidemic in South Africa: a model comparison study.

• DOI: 10.1186/s12889-023-16995-9
• 发表时间: 2023-10-27
• 期刊: BMC public health
• 影响因子: 4.5

Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models.

• DOI: 10.1016/s2214-109x(22)00515-0
• 发表时间: 2023-02
• 期刊: LANCET GLOBAL HEALTH
• 影响因子: 34.3
• 作者: Bansi-Matharu, Loveleen;Mudimu, Edinah;Martin-Hughes, Rowan;Hamilton, Matt;Johnson, Leigh;ten Brink, Debra;Stover, John;Meyer-Rath, Gesine;Kelly, Sherrie L.;Jamieson, Lise;Cambiano, Valentina;Jahn, Andreas;Cowan, Frances M.;Mangenah, Collin;Mavhu, Webster;Chidarikire, Thato;Toledo, Carlos;Revill, Paul;Sundaram, Maaya;Hatzold, Karin;Yansaneh, Aisha;Apollo, Tsitsi;Kalua, Thoko;Mugurungi, Owen;Kiggundu, Valerian;Zhang Shufang;Nyirenda, Rose;Phillips, Andrew;Kripke, Katharine;Bershteyn, Anna
• 通讯作者: Bershteyn, Anna

Engagement in HIV services over time among young women who sell sex in Zimbabwe.

• DOI: 10.1371/journal.pone.0270298
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7

Potential Impact and Cost-Effectiveness of Condomless-Sex-Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance.

• DOI: 10.1093/infdis/jiz667
• 发表时间: 2021-04-23
• 期刊: The Journal of infectious diseases
• 作者: Phillips AN;Cambiano V;Johnson L;Nakagawa F;Homan R;Meyer-Rath G;Rehle T;Tanser F;Moyo S;Shahmanesh M;Castor D;Russell E;Jamieson L;Bansi-Matharu L;Shroufi A;Barnabas RV;Parikh UM;Mellors JW;Revill P
• 通讯作者: Revill P

The potential role of long-acting injectable cabotegravir-rilpivirine in the treatment of HIV in sub-Saharan Africa: a modelling analysis.

• DOI: 10.1016/s2214-109x(21)00025-5
• 发表时间: 2021-05
• 期刊: The Lancet. Global health
• 作者: Phillips AN;Bansi-Matharu L;Cambiano V;Ehrenkranz P;Serenata C;Venter F;Pett S;Flexner C;Jahn A;Revill P;Garnett GP
• 通讯作者: Garnett GP