The South African Department of Science and Technology / National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, University of Stellenbosch, Cape Town, South Africa.
PLoS One. 2013 Jul 26;8(7):e69437. doi: 10.1371/journal.pone.0069437. Print 2013.
Swaziland's severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT).
Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey.
By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4<350/mm(3), with progressively improving patient retention and survival. As of 2010, 88% of health facilities providing antenatal care offered comprehensive PMTCT services. The HTC program recorded a halving in the proportion of adults tested who were HIV-infected; similarly HIV infection rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates among hospital patients diagnosed with HIV/AIDS started to decrease from 2005-6 in adults and especially in children, contrasting with stable case fatality for other causes including TB. All-cause child in-patient case fatality rates started to decrease from 2005-6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%.
Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level.
斯威士兰的艾滋病毒疫情十分严重，自 20 世纪 80 年代末以来，该国就采取了早期的国家应对措施，并自 2004 年启动国家抗逆转录病毒治疗（ART）项目以来，定期报告项目结果。我们评估了与 ART、艾滋病毒检测和咨询（HTC）、结核病（TB）和预防母婴传播（PMTCT）相关的有效性结果和死亡率趋势。
三角数据包括干预措施的覆盖率和根据项目登记册（2001-2010 年）、按年龄和性别细分的医院入院和死亡情况（2001-2010 年）以及 1997 年和 2007 年人口普查和 2007 年人口与健康调查得出的人口死亡率估计值。
到 2010 年，ART 覆盖了估计有 350/mm³以下 CD4 细胞的艾滋病毒/艾滋病患者的 70%，患者保留率和存活率逐步提高。截至 2010 年，88%提供产前保健的卫生机构提供全面的 PMTCT 服务。HTC 项目记录显示，接受检测的成年人中艾滋病毒感染者的比例减少了一半；同样，2007 年至 2010 年期间，艾滋病毒暴露婴儿的艾滋病毒感染率也减少了一半。艾滋病毒/艾滋病患者在医院被诊断后的病死率开始从 2005-6 年开始在成年人中，尤其是在儿童中下降，而其他原因（包括结核病）的病死率保持稳定。2005-6 年开始，所有原因的儿童住院病死率开始下降。2010 年，结核病病例报告以及通报结核病患者中艾滋病毒/TB 合并感染的比例继续稳步上升，而对合并感染患者进行艾滋病毒检测和 CPT 的覆盖率增加到 80%以上。
在艾滋病毒流行率高但稳定且呈下降趋势的背景下，我们记录了自 2004 年以来国家扩大艾滋病毒应对措施后死亡率下降的早期证据。要将影响归因于具体干预措施（而不是自然流行动态），还需要来自未来家庭调查的额外数据，以及改善地区一级的常规（项目、监测和医院）数据。
