Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Lancet Infect Dis. 2013 Jan;13(1):65-76. doi: 10.1016/S1473-3099(12)70273-6.
The promise of combination HIV prevention-the application of multiple HIV prevention interventions to maximise population-level effects-has never been greater. However, to succeed in achieving significant reductions in HIV incidence, an additional concept needs to be considered: combination implementation. Combination implementation for HIV prevention is the pragmatic, localised application of evidence-based strategies to enable high sustained uptake and quality of interventions for prevention of HIV. In this Review, we explore diverse implementation strategies including HIV testing and counselling models, task shifting, linkage to and retention in care, antiretroviral therapy support, behaviour change, demand creation, and structural interventions, and discusses how they could be used to complement HIV prevention efforts such as medical male circumcision and treatment as prevention. HIV prevention and treatment have arrived at a pivotal moment when combination efforts might result in substantial enough population-level effects to reverse the epidemic and drive towards elimination of HIV. Only through careful consideration of how to implement and operationalise HIV prevention interventions will the HIV community be able to move from clinical trial evidence to population-level effects.
联合艾滋病预防的前景——应用多种艾滋病预防干预措施来最大限度地提高人群层面的效果——从未如此之大。然而，要成功实现艾滋病毒发病率的显著降低，还需要考虑另一个概念：联合实施。联合实施艾滋病预防是将循证策略切实应用于当地，以实现预防艾滋病毒的干预措施的高持续接受度和高质量。在这篇综述中，我们探讨了包括艾滋病毒检测和咨询模式、任务转移、与护理的联系和保留、抗逆转录病毒治疗支持、行为改变、需求创造和结构干预在内的多种实施策略，并讨论了它们如何能够用于补充艾滋病预防工作，如医学男性包皮环切术和治疗即预防。艾滋病预防和治疗正处于一个关键时刻，联合努力可能会产生足够大的人群层面效果，从而扭转疫情，并推动实现消除艾滋病毒的目标。只有通过仔细考虑如何实施和运作艾滋病预防干预措施，艾滋病界才能将临床试验证据转化为人群层面的效果。
