性传播感染控制和艾滋病毒传播预防:修补破碎的范例。

Control of sexually transmitted infections and prevention of HIV transmission: mending a fractured paradigm.

机构信息

World Health Organization Regional Office for South-East Asia, New Delhi, India.

出版信息

Bull World Health Organ. 2009 Nov;87(11):858-65. doi: 10.2471/blt.08.059212.

Abstract

Control of sexually transmitted infections (STIs) is feasible, leads to improved sexual and reproductive health and contributes to preventing HIV transmission. The most advanced HIV epidemics have developed under conditions of poor STI control, particularly where ulcerative STIs were prevalent. Several countries that have successfully controlled STIs have documented stabilization or reversal of their HIV epidemics. STI control is a public health outcome measured by reduced incidence and prevalence. The means to achieve this include: (i) targeting and outreach to populations at greatest risk; (ii) promoting and providing condoms and other means of prevention; (iii) effective clinical interventions; (iv) an enabling environment; and (v) reliable data. Clinical services include STI case management, screening and management of STIs in sex partners. Syndromic case management is effective for most symptomatic curable STIs and screening strategies exist to detect some asymptomatic infections. Presumptive epidemiologic treatment of sex partners and sex workers complement efforts to interrupt transmission and reduce prevalence. Clinical services alone are insufficient for control since many people with STIs do not attend clinics. Outreach and peer education have been effectively used to reach such populations. STI control requires effective interventions with core populations whose rates of partner change are high enough to sustain transmission. Effective, appropriate targeting is thus necessary and often sufficient to reduce prevalence in the general population. Such efforts are most effective when combined with structural interventions to ensure an enabling environment for prevention. Reliable surveillance and related data are critical for designing and evaluating interventions and for assessing control efforts.

摘要

性传播感染(STI)的控制是可行的,可改善性健康和生殖健康,并有助于预防 HIV 传播。最先进的 HIV 流行是在 STI 控制不佳的情况下发展起来的,特别是在溃疡性 STI 流行的情况下。一些成功控制 STI 的国家已经记录了其 HIV 流行的稳定或逆转。STI 控制是通过降低发病率和患病率来衡量的公共卫生结果。实现这一目标的方法包括:(i)针对高危人群进行目标定位和外展;(ii)促进和提供避孕套和其他预防手段;(iii)有效的临床干预;(iv)有利的环境;和(v)可靠的数据。临床服务包括 STI 病例管理、性伴侣的 STI 筛查和管理。症状性可治愈 STI 的综合征病例管理是有效的,并且存在筛查策略来检测一些无症状感染。对性伴侣和性工作者进行推定流行病学治疗,可补充中断传播和降低流行率的努力。仅临床服务不足以控制 STI,因为许多患有 STI 的人不去诊所。外展和同伴教育已被有效地用于接触这些人群。STI 控制需要对具有足够高的伴侣变化率的核心人群进行有效的干预,以维持传播。因此,有效的、适当的目标定位对于降低普通人群的患病率是必要的,而且往往是足够的。当与确保预防有利环境的结构性干预措施相结合时,此类努力最为有效。可靠的监测和相关数据对于设计和评估干预措施以及评估控制工作至关重要。

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