Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa.
Curr Opin HIV AIDS. 2012 Mar;7(2):140-50. doi: 10.1097/COH.0b013e32834fc1df.
To reduce HIV incidence, treatment-as-prevention (TasP) requires high rates of HIV testing, and antiretroviral treatment (ART) uptake, retention, and adherence, which are currently not achieved in general populations in sub-Saharan Africa. We review the experimental evidence on interventions to increase these rates.
In four rapid reviews, we found nine randomized controlled trials (RCTs) on HIV-testing uptake, two on ART uptake, one on ART retention, and 15 on ART adherence in sub-Saharan Africa. Only two RCTs on HIV testing investigated an intervention in general populations; the other examined interventions in selected groups (employees, or individuals attending public-sector facilities for services). One RCT demonstrated that nurse-managed ART led to the same retention rates as physician-managed ART, but failed to show how to increase retention to the rates required for successful TasP. Although the evidence on ART adherence is strongest - several RCTs demonstrate the effectiveness of cognitive and behavioural interventions - contradictory results in different settings suggest that the precise intervention content, or the context, are crucial for effectiveness.
Future studies need to test the effectiveness of interventions to increase testing and treatment uptake, retention, and adherence under TasP, that is, ART for all HIV-infected individuals, independent of disease stage.
目的综述：为降低艾滋病毒发病率，治疗即预防（TasP）需要高比例的艾滋病毒检测，以及接受抗逆转录病毒治疗（ART）的人数、保持治疗和坚持治疗，而这些目前在撒哈拉以南非洲的一般人群中并未实现。我们综述了旨在提高这些比例的干预措施的实验证据。
最新发现：在四项快速综述中，我们发现了九项关于撒哈拉以南非洲艾滋病毒检测接受度、两项关于接受抗逆转录病毒治疗、一项关于抗逆转录病毒治疗保持率和十五项关于抗逆转录病毒治疗坚持率的随机对照试验。仅有两项关于艾滋病毒检测的随机对照试验调查了一般人群中的干预措施；其他的研究则在选定人群（员工或到公立部门机构接受服务的个人）中进行了干预措施的研究。一项随机对照试验表明，护士管理的抗逆转录病毒治疗与医生管理的抗逆转录病毒治疗具有相同的保持率，但未能表明如何将保持率提高到成功实施 TasP 所需的水平。尽管关于抗逆转录病毒治疗坚持率的证据最强——几项随机对照试验都证明了认知和行为干预的有效性——但不同环境下的相互矛盾的结果表明，干预内容的确切性或环境对有效性至关重要。
总结：未来的研究需要测试在 TasP 下提高检测和治疗接受度、保持率和坚持率的干预措施的有效性，也就是说，对所有艾滋病毒感染个体，无论疾病阶段如何，都应进行抗逆转录病毒治疗。
