Department of Healthcare Policy and Research, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0430, USA.
J Acquir Immune Defic Syndr. 2013 Jun 1;63(2):e40-8. doi: 10.1097/QAI.0b013e3182918875.
Guidelines recommend antiretroviral therapy (ART) initiation at CD4 <350 cells per microliter for HIV-infected individuals in resource-limited settings. However, funding for treatment expansion remains uncertain. We forecast the mortality impact of ART expansion alternatives in Haiti.
We used data from Haiti to develop a country-specific model of HIV disease. The model projects the mortality, total number of HIV-infected individuals, and number and coverage (percentage of those eligible) on ART by simulating cohorts of HIV-infected individuals over 10 years. Five ART expansion scenarios, ranging from fully expanded ART (best case) to No New ART (worst case), were assessed.
By 2010, the model predicts 103,500 individuals living with HIV in Haiti, of whom 27,300 were estimated to receive ART. Continuing ART initiation at current rates requires increasing the number on ART to 43,300 by 2020 (56% coverage), with 89,700 deaths estimated between 2010 and 2020. The number on ART could increase by 7400 (+17.1%, best case) or decrease by 25,600 (-59.1%, worst case), resulting in 19,500 deaths averted and 9900 fewer in care awaiting ART (best versus worst case). Results are sensitive to untreated disease progression and pre-ART loss from care. Increased HIV testing, linkage to care, and retention in care can avert additional deaths and achieve nearly 80% ART coverage with optimal policy improvements.
In resource-limited settings, continued improvements in HIV treatment access will save lives. Efforts to efficiently expand ART access should remain a global priority.
在资源有限的环境下，指南建议对 CD4 每微升细胞数<350 的艾滋病毒感染者启动抗逆转录病毒治疗（ART）。然而，治疗扩展的资金仍然不确定。我们预测了海地扩大 ART 治疗选择的死亡率影响。
我们使用海地的数据开发了一种特定于该国的 HIV 疾病模型。该模型通过模拟 HIV 感染者 10 年内的队列，预测死亡率、HIV 感染者总数、以及接受 ART 的人数和覆盖率（符合条件者的百分比）。评估了五种 ART 扩展方案，范围从完全扩展 ART（最佳情况）到没有新的 ART（最差情况）。
到 2010 年，模型预测海地将有 103500 人携带 HIV，其中 27300 人估计将接受 ART。继续按照目前的速度启动 ART 需要到 2020 年将接受 ART 的人数增加到 43300 人（56%的覆盖率），估计 2010 年至 2020 年期间将有 89700 人死亡。接受 ART 的人数可以增加 7400 人（增加 17.1%，最佳情况）或减少 25600 人（减少 59.1%，最差情况），这将避免 19500 人死亡和 9900 人在等待接受 ART 时死亡（最佳情况与最差情况）。结果对未经治疗的疾病进展和接受 ART 前因护理而失去联系敏感。增加 HIV 检测、与护理联系以及保持护理可以避免更多的死亡，并通过最佳政策改进实现近 80%的 ART 覆盖率。
在资源有限的环境下，继续改善 HIV 治疗的可及性将挽救生命。努力高效地扩大 ART 的可及性应仍然是全球的优先事项。
