Chemaitelly Hiam, Awad Susanne F, Shelton James D, Abu-Raddad Laith J
Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
Bureau for Global Health, United States Agency for International Development, Washington, DC, USA.
J Int AIDS Soc. 2014 Feb 21;17(1):18765. doi: 10.7448/IAS.17.1.18765. eCollection 2014.
The recent availability of efficacious prevention interventions among stable couples offers new opportunities for reducing HIV incidence in sub-Saharan Africa. Understanding the dynamics of HIV incidence among stable couples is critical to inform HIV prevention strategy across sub-Saharan Africa.
We quantified the sources of HIV incidence arising among stable couples in sub-Saharan Africa using a cohort-type mathematical model parameterized by nationally representative data. Uncertainty and sensitivity analyses were incorporated.
HIV incidence arising among stable concordant HIV-negative couples contribute each year, on average, 29.4% of total HIV incidence; of those, 22.5% (range: 11.1%-39.8%) are infections acquired by one of the partners from sources external to the couple, less than 1% are infections acquired by both partners from external sources within a year and 6.8% (range: 3.6%-11.6%) are transmissions to the uninfected partner in the couple in less than a year after the other partner acquired the infection from an external source. The mean contribution of stable HIV sero-discordant couples to total HIV incidence is 30.4%, with most of those, 29.7% (range: 9.1%-47.9%), being due to HIV transmissions from the infected to the uninfected partner within the couple. The remaining incidence, 40.2% (range: 23.7%-64.6%), occurs among persons not in stable couples.
Close to two-thirds of total HIV incidence in sub-Saharan Africa occur among stable couples; however, only half of this incidence is attributed to HIV transmissions from the infected to the uninfected partner in the couple. The remaining incidence is acquired through extra-partner sex. Substantial reductions in HIV incidence can be achieved only through a prevention approach that targets all modes of HIV exposure among stable couples and among individuals not in stable couples.
近期在稳定伴侣中出现了有效的预防干预措施，这为降低撒哈拉以南非洲地区的艾滋病毒发病率提供了新机遇。了解稳定伴侣中艾滋病毒发病率的动态变化对于为撒哈拉以南非洲地区的艾滋病毒预防策略提供依据至关重要。
我们使用由具有全国代表性的数据参数化的队列型数学模型，对撒哈拉以南非洲地区稳定伴侣中艾滋病毒发病率的来源进行了量化。纳入了不确定性和敏感性分析。
稳定的艾滋病毒抗体均为阴性的伴侣中每年产生的艾滋病毒发病率平均占艾滋病毒总发病率的29.4%；其中，22.5%（范围：11.1%-39.8%）是一方伴侣从伴侣关系之外的来源感染的，不到1%是双方伴侣在一年内从外部来源感染上的，6.8%（范围：3.6%-11.6%）是在一方伴侣从外部来源感染后不到一年的时间内传染给伴侣关系中未感染伴侣的。稳定的艾滋病毒血清学不一致的伴侣对艾滋病毒总发病率的平均贡献为30.4%，其中大部分，即29.7%（范围：9.1%-47.9%），是由于伴侣关系中感染的一方将艾滋病毒传染给未感染的一方。其余的发病率，即40.2%（范围：23.7%-64.6%），发生在非稳定伴侣的人群中。
撒哈拉以南非洲地区近三分之二的艾滋病毒总发病率发生在稳定伴侣中；然而，这一发病率中只有一半归因于伴侣关系中感染的一方将艾滋病毒传染给未感染的一方。其余的发病率是通过伴侣之外的性行为感染的。只有通过针对稳定伴侣和非稳定伴侣中所有艾滋病毒暴露方式的预防方法，才能大幅降低艾滋病毒发病率。
