Can mental health services break the cycle perpetuating HIV hotspots in sub-Saharan Africa?

摘要/总结 撒哈拉以南非洲的艾滋病毒发病率正在下降，但有些地区尚未走上实现 联合国在可持续发展中设定的年新增感染率<0.1%的“控疫”目标 发展目标常见的精神障碍（CMD），如抑郁症和焦虑症， 在艾滋病毒感染者中流行，干扰终身坚持治疗，并与 危险的性行为因此，撒哈拉以南非洲的卫生当局认识到CMD的重要性 作为艾滋病毒预防的组成部分，但尚未确定将这些重点放在哪里 服务最有可能无法实现流行病控制目标的地区被称为艾滋病毒热点地区。我们 假设有不同类型的热点：一些是由危险行为驱动的，一些是由随机行为引起的。 机会，以及过去出现的一些，并已陷入一个积极的反馈循环， 发病率和患病率。CMD筛查和治疗的最佳作用可能因热点类型而异。 我们提出用数学建模来预测热点的发生，确定如何分类 他们的类型，并估计CMD筛查和治疗的最佳作用，为每一个艾滋病毒热点类型。下一个是 我们将与两个撒哈拉以南非洲国家--肯尼亚和赞比亚--的专家合作， 将CMD筛查和治疗纳入最佳艾滋病毒应对措施，无论是在全国范围内还是在重点 艾滋病热点。最后，我们将使用信息价值的方法来确定是否发现成本 对热点进行分类是有道理的，因为针对每个热点的艾滋病毒应对措施具有针对性和定制性， 热点我们希望我们的项目能够指导卫生部和实施者扩大CMD的规模 治疗，同时也扩大了对艾滋病毒流行病的基本认识，这是假设， 包含热点由于基本的数学属性，如分形和混沌。这些假设 20年来，艾滋病毒的地理空间数据和方法一直没有得到重新审视。我们预计 我们的项目将通过扩大热点目标， 促进将CMD护理纳入艾滋病毒应对措施。

ABSTRACT/SUMMARY HIV incidence is declining in sub-Saharan Africa (SSA), but some areas are not on track to achieve the “epidemic control” target of <0.1% annual rate of new infections set by the United Nations in the Sustainable Development Goals. Common mental disorders (CMD) such as depression and anxiety are extremely prevalent among people living with HIV, interfere with lifelong adherence to treatment, and are associated with risky sexual behaviors. Accordingly, health authorities in SSA are recognizing the importance of CMD screening and treatment as a component of HIV prevention, but have not yet determined where to focus these services. The areas at greatest risk of missing the epidemic control target are known as HIV hotspots. We hypothesize that there are different types of hotspots: some driven by risky behaviors, some arising by random chance, and some that emerged in the past and have become trapped in a positive feedback loop between incidence and prevalence. The optimal role of CMD screening and treatment may differ by hotspot type. We propose to use mathematical modeling to predict the occurrence of hotspots, determine how to classify them by type, and estimate the optimal role of CMD screening and treatment for each HIV hotspot type. Next, we will work with experts in two SSA countries – Kenya and Zambia – to develop an investment case for incorporating CMD screening and treatment into an optimal HIV response, either nationally or with a focus on HIV hotspots. Finally, we will use a value-of-information approach to determine whether the costs of finding and classifying hotspots are justified by the benefits of targeting and customizing the HIV response to each hotspot. We expect our project to guide Ministries of Health and implementers about scale-up of CMD treatment in SSA while also expanding basic understanding of HIV epidemics, which were hypothesized to contain hotspots due to fundamental mathematical properties such as fractals and chaos. These hypotheses have not been revisited in two decades, while geospatial HIV data and methods have proliferated. We expect that our project will enable more effective HIV prevention in SSA by expanding hotspot targeting and by facilitating the integration of CMD care into the HIV response.