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

摘要/摘要 埃斯瓦蒂尼是世界上艾滋病毒感染率最高的国家，目前每四个成年人中就有一个以上携带艾滋病毒。 减轻艾滋病毒/艾滋病负担的非凡努力使埃斯瓦蒂尼成为第一个非洲国家 超越联合国艾滋病规划署“95-95-95”的目标，即95%的艾滋病毒携带者(≥)确诊为艾滋病病毒携带者，提供 95%的确诊患者接受了≥治疗，95%的接受治疗的患者实现了≥病毒载量抑制， 导致艾滋病毒死亡率大幅下降。相比之下，死于许多非传染性疾病 埃斯瓦蒂尼的非传染性疾病正在增加。心血管疾病死亡，第二大死因 在埃斯瓦蒂尼艾滋病毒/艾滋病之后，自2000年以来上升了11%。死于癌症、糖尿病、慢性肾脏 疾病、自残和暴力在同一时期增加了12%-35%。因此， 埃斯瓦蒂尼卫生部(MoH)对利用艾滋病毒护理系统改善护理和 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 可以为埃斯瓦蒂尼的所有居民提供护理，但可以创建健康福利方案(HBP)以 在国家卫生预算的范围内尽可能提供最大的卫生福利 医护人员。此外，像许多其他国家一样，埃斯瓦蒂尼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。这些事件可能会导致 中断常规医疗保健提供的外源性冲击，这可能会影响到优先考虑哪些 要提供的健康服务。例如，对初级预防的投资可能成为一种更有效的选择。 在考虑到外源性疾病的可能性时，持续提供疾病治疗 未来几十年对医疗体系的冲击。我们的团队结合了模特、健康方面的专业知识 经济、艾滋病毒/非传染性疾病护理一体化和埃斯瓦蒂尼的卫生系统--包括现任 埃斯瓦蒂尼卫生部的规划。我们的研究将(目标1)确定哪些非艾滋病毒健康服务 考虑到不断变化的人口统计和健康风险，与艾滋病毒护理一起提供将是高效的 埃斯瓦蒂尼的艾滋病毒携带者，(目标2)决定在埃斯瓦蒂尼的HBP中包括哪些服务，以最大限度地提高 资源限制下的人口健康，以及(目标3)评估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复原力。此外，埃斯瓦蒂尼 很可能是撒哈拉以南非洲其他地方出现的卫生政策问题的先驱，在那里 各国正在努力在未来几年超过“95-95-95”的治疗目标。因此，我们将 在东部、中部和南部非洲卫生界传播成果，扩大我们的 研究并为今后的工作做好准备。

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.