Leveraging HIV care systems to improve cardiovascular disease prevention in the Kingdom of eSwatini

摘要/总结 斯威士兰是世界上艾滋病毒感染率最高的地区，目前每四个成年人中就有一个以上感染艾滋病毒。 在减轻艾滋病毒/艾滋病负担方面所做的非凡努力使斯威士兰成为第一个非洲国家， 超过联合国艾滋病规划署的“95-95-95”目标，即诊断出≥95%的艾滋病毒感染者， ≥95%的确诊患者接受治疗，≥95%的治疗患者实现病毒载量抑制， 导致艾滋病死亡率大幅下降。相比之下，许多非传染性疾病造成的死亡 在斯威士兰的非传染性疾病正在增加。死于心血管疾病的人数，这是第二大死因 自2000年以来，艾滋病毒/艾滋病在斯威士兰上升了11%。死于癌症、糖尿病、慢性肾病 疾病、自残和暴力在同一时期增加了12-35%。因此 斯威士兰卫生部（MoH）非常有兴趣利用艾滋病毒护理系统来改善护理， 预防心血管疾病和其他高负担的非传染性疾病。由于资源限制，并非所有非传染性疾病 可以向所有斯威士兰居民提供护理，但可以创建健康福利包（HBP）， 在国家卫生预算和卫生干部的范围内提供尽可能多的卫生福利， 医护人员。此外，与许多其他国家一样，斯威士兰面临着越来越大的流行病风险， 冲突以及人口增长和气候变化造成的自然灾害。这些事件可能导致 中断常规医疗服务的外源性冲击，这可能对优先考虑 提供的健康服务。例如，对初级预防的投资可能成为一个更有效的选择 当考虑到外源性疾病的可能性时， 在未来几十年里，医疗保健系统将面临巨大的冲击。我们的团队结合了建模，健康， 经济学，艾滋病毒/非传染性疾病护理一体化，和斯威士兰的卫生系统-包括现任主任 斯威士兰卫生部的规划。我们的研究将（目标1）确定哪些非艾滋病毒卫生服务 考虑到人口统计学和人群健康风险的不断变化， 在斯威士兰的艾滋病毒感染者，（目标2）确定哪些服务包括在斯威士兰的HBP，以最大限度地提高 （目标3）评估卫生系统效率与卫生系统效率之间的权衡 以及对流行病、冲突和自然灾害等外部冲击的抵御能力。此外，斯威士兰 很可能成为撒哈拉以南非洲其他地区出现的卫生政策问题的先驱，而其他地区 各国正在努力在未来几年超过“95-95-95”治疗目标。因此，我们将 在东部、中部和南部非洲卫生共同体传播成果，以扩大我们的 研究并为今后的工作奠定基础。

ABSTRACT/SUMMARY ESwatini has the world’s highest prevalence of HIV, with more than one in four adults currently living with HIV. Extraordinary efforts at reducing the burden of HIV/AIDS have led eSwatini to become the first African country to surpass the UNAIDS “95-95-95” goals of diagnosing ≥95% of people living with HIV (PLHIV), providing treatment to ≥95% of those diagnosed, and achieving viral load suppression in ≥95% of those on treatment, leading to dramatic reductions in HIV mortality. In contrast, deaths from many non-communicable diseases (NCDs) in eSwatini are increasing. Deaths from cardiovascular disease, the second-leading cause of death after HIV/AIDS in eSwatini, have risen by 11% since 2000. Deaths from cancer, diabetes, chronic kidney disease, self-harm, and violence have increased by 12-35% over the same time period. Accordingly, the eSwatini Ministry of Health (MoH) is keenly interested in leveraging HIV care systems to improve care and prevention for cardiovascular disease and other high-burden NCDs. Due to resource constraints, not all NCD care can be provided to all residents of eSwatini, but a health benefits package (HBP) could be created to deliver the greatest possible health benefits within the limits of the country’s health budget and cadre of healthcare personnel. Additionally, like many other countries, eSwatini faces a growing risk of pandemics, conflict, and natural disasters due to population growth and climate change. These events can cause exogenous shocks that interrupt routine healthcare delivery, which may have implications for prioritizing which health services to offer. For example, investments in primary prevention may become a more efficient option than continuously delivering treatment for diseases when taking into consideration the likelihood of exogenous shocks to the healthcare system over coming decades. Our team combines expertise in modeling, health economics, HIV/NCD care integration, and eSwatini’s health system – including the current Director of Planning for the eSwatini Ministry of Health. Our study will (Aim 1) determine which non-HIV health services will be efficient to co-deliver with HIV care given the evolving demographics and health risks among people living with HIV in eSwatini, (Aim 2) determine which services to include in eSwatini’s HBP to maximize population health under resource constraints, and (Aim 3) assess trade-offs between health system efficiency and resilience to exogenous shocks such as pandemics, conflict, and natural disasters. Additionally, eSwatini is likely to be a forerunner of health policy questions to arise elsewhere in sub-Saharan Africa, where other countries are working to surpass the “95-95-95” treatment goals in coming years. Accordingly, we will disseminate results in the Eastern, Central, and Southern Africa Health Community to amplify the impact of our research and set the stage for future work.