aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa bUniversity College London Institute of Child Health, London, UK cDepartment of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
AIDS. 2013 Sep 10;27(14):2301-5. doi: 10.1097/QAD.0b013e328362e832.
To investigate HIV prevalence trends in a rural South African community after the scale-up of antiretroviral treatment (ART) in 2004.
We estimated adult HIV prevalence (ages 15-49 years) using data from a large, longitudinal, population-based HIV surveillance in rural KwaZulu-Natal, South Africa, over the period from 2004 (the year when the public-sector ART scale-up started) to 2011. We control for selection effects due to surveillance nonparticipation using multiple imputation. We further linked the surveillance data to patient records from the local HIV treatment program to estimate ART coverage.
ART coverage of all HIV-infected people in this community increased from 0% in 2004 to 31% in 2011. Over the same observation period adult HIV prevalence increased steadily from 21 to 29%. The change in overall HIV prevalence is nearly completely explained by an increase of HIV-infected people receiving ART, and it is largely driven by increases in HIV prevalence in women and men older than 24 years.
The observed dramatic increase in adult HIV prevalence can most likely be explained by increased survival of HIV-infected people due to ART. Future studies should decompose HIV prevalence trends into HIV incidence and HIV-specific mortality changes to further improve the causal attribution of prevalence increases to treatment success rather than prevention failure.
在 2004 年抗逆转录病毒治疗（ART）大规模推广后，调查南非农村社区艾滋病毒流行趋势。
我们使用南非夸祖鲁-纳塔尔省农村地区一项大型、纵向、基于人群的艾滋病毒监测数据，估计了成年人艾滋病毒流行率（15-49 岁）。在 2004 年（公共部门开始推广 ART 的那一年）至 2011 年期间，我们使用多次插补控制了因监测不参与而产生的选择效应。我们进一步将监测数据与当地艾滋病毒治疗计划的患者记录相关联，以估计 ART 的覆盖率。
该社区所有艾滋病毒感染者接受 ART 的比例从 2004 年的 0%增加到 2011 年的 31%。在同一观察期内，成年人艾滋病毒流行率从 21%稳步上升到 29%。总体艾滋病毒流行率的变化几乎完全可以归因于接受 ART 的艾滋病毒感染者人数的增加，这主要是由于 24 岁以上的妇女和男子中艾滋病毒感染率的增加所致。
观察到的成年人艾滋病毒流行率的急剧上升很可能可以解释为接受 ART 的艾滋病毒感染者的生存率提高。未来的研究应该将艾滋病毒流行率趋势分解为艾滋病毒发病率和艾滋病毒特异性死亡率的变化，以进一步改善将流行率上升归因于治疗成功而不是预防失败的因果关系。
