Department of Infectious Disease Epidemiology, Imperial College London, UK.
J Int AIDS Soc. 2011 May 24;14:27. doi: 10.1186/1758-2652-14-27.
In June 2001, the United Nations General Assembly Special Session (UNGASS) set a target of reducing HIV prevalence among young women and men, aged 15 to 24 years, by 25% in the worst-affected countries by 2005, and by 25% globally by 2010. We assessed progress toward this target in Manicaland, Zimbabwe, using repeated household-based population serosurvey data. We also validated the representativeness of surveillance data from young pregnant women, aged 15 to 24 years, attending antenatal care (ANC) clinics, which UNAIDS recommends for monitoring population HIV prevalence trends in this age group. Changes in socio-demographic characteristics and reported sexual behaviour are investigated.
Progress towards the UNGASS target was measured by calculating the proportional change in HIV prevalence among youth and young ANC attendees over three survey periods (round 1: 1998-2000; round 2: 2001-2003; and round 3: 2003-2005). The Z-score test was used to compare differences in trends between the two data sources. Characteristics of participants and trends in sexual risk behaviour were analyzed using Student's and two-tailed Z-score tests.
HIV prevalence among youth in the general population declined by 50.7% (from 12.2% to 6.0%) from round 1 to 3. Intermediary trends showed a large decline from round 1 to 2 of 60.9% (from 12.2% to 4.8%), offset by an increase from round 2 to 3 of 26.0% (from 4.8% to 6.0%). Among young ANC attendees, the proportional decline in prevalence of 43.5% (from 17.9% to 10.1%) was similar to that in the population (test for differences in trend: p value=0.488) although ANC data significantly underestimated the population prevalence decline from round 1 to 2 (test for difference in trend: p value=0.003) and underestimated the increase from round 2 to 3 (test for difference in trend: p value=0.012). Reductions in risk behaviour between rounds 1 and 2 may have been responsible for general population prevalence declines.
In Manicaland, Zimbabwe, the 2005 UNGASS target to reduce HIV prevalence by 25% was achieved. However, most prevention gains occurred before 2003. ANC surveillance trends overall were an adequate indicator of trends in the population, although lags were observed. Behaviour data and socio-demographic characteristics of participants are needed to interpret ANC trends.
2001 年 6 月，联合国大会特别会议（UNGASS）设定了一个目标，即在 2005 年将受艾滋病影响最严重国家 15 至 24 岁青年男女中的艾滋病毒流行率降低 25%，到 2010 年在全球降低 25%。我们使用重复的基于家庭的人群血清学调查数据评估了津巴布韦马尼卡兰省在实现这一目标方面的进展。我们还验证了 15 至 24 岁参加产前护理 (ANC) 诊所的年轻孕妇监测数据的代表性，艾滋病规划署建议用该数据监测该年龄组人群艾滋病毒流行趋势。研究了社会人口特征和报告性行为的变化。
通过计算青年和年轻 ANC 就诊者在三个调查期间（第 1 轮：1998-2000 年；第 2 轮：2001-2003 年；第 3 轮：2003-2005 年）艾滋病毒流行率的比例变化来衡量 UNGASS 目标的进展情况。Z 分数检验用于比较两种数据源之间趋势的差异。使用学生和双尾 Z 分数检验分析参与者的特征和性风险行为趋势。
普通人群中年轻人的艾滋病毒流行率从第 1 轮到第 3 轮下降了 50.7%（从 12.2%降至 6.0%）。中间趋势显示，第 1 轮至第 2 轮大幅下降 60.9%（从 12.2%降至 4.8%），但第 2 轮至第 3 轮上升 26.0%（从 4.8%至 6.0%）。在年轻的 ANC 就诊者中，流行率下降 43.5%（从 17.9%降至 10.1%）与人群相似（趋势差异检验：p 值=0.488），尽管 ANC 数据从第 1 轮到第 2 轮显著低估了人群流行率下降（趋势差异检验：p 值=0.003），并低估了从第 2 轮到第 3 轮的上升（趋势差异检验：p 值=0.012）。第 1 轮和第 2 轮之间风险行为的减少可能是普通人群流行率下降的原因。
在津巴布韦马尼卡兰省，2005 年 UNGASS 将艾滋病毒流行率降低 25%的目标已经实现。然而，大多数预防成果都是在 2003 年之前取得的。ANC 监测总体趋势是人群趋势的一个充分指标，尽管存在滞后。需要行为数据和参与者的社会人口特征来解释 ANC 趋势。
