Heymer Kelly-Jean, Wilson David P
National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Darlinghurst, Sydney, NSW 2010, Australia.
Sex Health. 2011 Sep;8(3):280-94. doi: 10.1071/SH10084.
Discussion is currently taking place among international HIV/AIDS groups around increasing HIV testing and initiating earlier use of antiretroviral therapy (ART) among people diagnosed with HIV as a method to reduce the spread of HIV. In this study, we explore the expected epidemiological impact of this strategy in a small population in which HIV transmission is predominantly confined to men who have sex with men (MSM).
A deterministic mathematical transmission model was constructed to investigate the impacts of strategies that increase testing and treatment rates, and their likely potential to mitigate HIV epidemics among MSM. Our novel model distinguishes men in the population who are more easily accessible to prevention campaigns through engagement with the gay community from men who are not. This model is applied to the population of MSM in South Australia.
Our model-based findings suggest that increasing testing rates alone will have minimal impact on reducing the expected number of infections compared to current conditions. However, in combination with increases in treatment coverage, this strategy could lead to a 59-68% reduction in the number of HIV infections over the next 5 years. Targeting men who are socially engaged with the gay community would result in the majority of potential reductions in incidence, with only minor improvements possible by reaching all other MSM.
Investing in strategies that will achieve higher coverage and earlier initiation of treatment to reduce infectiousness of HIV-infected individuals could be an effective strategy for reducing incidence in a population of MSM.
目前，国际艾滋病病毒/艾滋病组织正在讨论增加艾滋病病毒检测，并在被诊断感染艾滋病病毒的人群中更早开始使用抗逆转录病毒疗法（ART），以此作为减少艾滋病病毒传播的一种方法。在本研究中，我们探讨了这一策略对一个小规模人群的预期流行病学影响，该人群中艾滋病病毒传播主要局限于男男性行为者（MSM）。
构建了一个确定性数学传播模型，以研究提高检测和治疗率的策略的影响，以及它们在男男性行为者中缓解艾滋病病毒流行的潜在可能性。我们的新模型区分了人群中通过参与同性恋社区更容易接触到预防活动的男性和不容易接触到的男性。该模型应用于南澳大利亚的男男性行为者人群。
我们基于模型的研究结果表明，与当前情况相比，仅提高检测率对减少预期感染人数的影响最小。然而，与提高治疗覆盖率相结合，这一策略可能会在未来5年内使艾滋病病毒感染人数减少59%至68%。针对与同性恋社区有社会交往的男性将导致发病率的大部分潜在降低，而覆盖所有其他男男性行为者只能带来微小改善。
投资于能够实现更高覆盖率和更早开始治疗以降低艾滋病病毒感染者传染性的策略，可能是减少男男性行为者人群发病率的有效策略。
