Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
Lancet. 2011 Nov 5;378(9803):1643-52. doi: 10.1016/S0140-6736(11)61390-1. Epub 2011 Oct 10.
The aim of Avahan, the India AIDS Initiative, was to reduce HIV transmission in the general population through large-scale prevention interventions focused on high-risk groups. It was launched in 2003 in six states with a total population of 300 million and a high HIV burden. We assessed the population-level effect of the first phase of Avahan (2003-08).
Population prevalence was estimated by use of adjustment factors from the national HIV sentinel surveillance data obtained annually from antenatal clinics. A mixed-effects multilevel regression model was developed to estimate the association between intervention intensity and population HIV prevalence trends, taking into account differences in the underlying epidemic trends in states and other potential confounders, and to estimate the number of HIV infections averted with Avahan.
80 (61%) of 131 districts in the six Avahan states received funding from Avahan for HIV prevention, as the only or shared source. Greater intensity of Avahan, measured as amount of grant per HIV population (medians US$24-432 in the six states), was significantly associated with lower HIV prevalence in Andhra Pradesh (p=0·004), Karnataka (p=0·004), and Maharashtra (p=0·008) states; this association was not significant in Tamil Nadu (p=0·06), Manipur (p=0·62), and Nagaland (p=0·67). Overall, we estimated that 100,178 HIV infections (95% CI 25,897-207,713) were averted at the population level from 2003 up to 2008 as a result of Avahan.
The results of our analysis suggest that Avahan had a beneficial effect in reducing HIV prevalence at the population level over 5 years of programme implementation in some of the states. With stagnating funding for HIV prevention globally, our findings support investment in well planned and managed HIV prevention programmes in low-income and middle-income countries.
Bill & Melinda Gates Foundation.
印度艾滋病倡议“阿伐汗”旨在通过针对高危人群的大规模预防干预措施，减少普通人群中的艾滋病毒传播。该项目于 2003 年在六个拥有 3 亿人口和高艾滋病毒负担的邦启动。我们评估了“阿伐汗”第一阶段（2003-2008 年）的人群效果。
使用从每年从产前诊所获得的全国艾滋病毒哨点监测数据中的调整因素估计人群流行率。采用混合效应多水平回归模型，考虑各州基础流行趋势的差异以及其他潜在混杂因素，估计干预强度与人群艾滋病毒流行趋势之间的关联，并估计通过“阿伐汗”避免的艾滋病毒感染人数。
六个“阿伐汗”邦中的 131 个区中有 80 个（61%）获得“阿伐汗”提供的艾滋病毒预防资金，作为唯一或共同来源。衡量“阿伐汗”资金强度的指标是每艾滋病毒人群的赠款额（六个邦的中位数为 24-432 美元），与安得拉邦（p=0·004）、卡纳塔克邦（p=0·004）和马哈拉施特拉邦（p=0·008）的艾滋病毒流行率较低显著相关；在泰米尔纳德邦（p=0·06）、曼尼普尔邦（p=0·62）和那加兰邦（p=0·67），这种相关性不显著。总的来说，我们估计，由于“阿伐汗”的实施，2003 年至 2008 年期间，人群层面避免了 100178 例艾滋病毒感染（95%CI25897-207713）。
我们的分析结果表明，在一些邦实施了五年的方案后，“阿伐汗”在降低人群艾滋病毒流行率方面产生了有益影响。在全球艾滋病毒预防资金停滞不前的情况下，我们的研究结果支持在低收入和中等收入国家投资于规划良好和管理良好的艾滋病毒预防方案。
比尔和梅琳达·盖茨基金会。
