Roxby Alison C, Unger Jennifer A, Slyker Jennifer A, Kinuthia John, Lewis Andrew, John-Stewart Grace, Walson Judd L
Curr HIV/AIDS Rep. 2014 Jun;11(2):119-27. doi: 10.1007/s11904-014-0203-2.
Effective biomedical and structural HIV prevention approaches are being implemented throughout sub-Saharan Africa. A "lifecycle approach" to HIV prevention recognizes the interconnectedness of the health of women, children and adolescents, and prioritizes interventions that have benefits across these populations. We review new biomedical prevention strategies for women, adolescents and children, structural prevention approaches, and new modalities for eliminating infant HIV infection, and discuss the implications of a lifecycle approach for the success of these methods. Some examples of the lifecycle approach include evaluating education and HIV prevention strategies among adolescent girls not only for their role in reducing risk of HIV infection and early pregnancy, but also to promote healthy adolescents who will have healthier future children. Similarly, early childhood interventions such as exclusive breastfeeding not only prevent HIV, but also contribute to better child and adolescent health outcomes. The most ambitious biomedical infant HIV prevention effort, Option B+, also represents a lifecycle approach by leveraging the prevention benefits of optimal HIV treatment for mothers; maternal survival benefits from Option B+ may have ultimately more health impact on children than the prevention of infant HIV in isolation. The potential for synergistic and additive benefits of lifecycle interventions should be considered when scaling up HIV prevention efforts in sub-Saharan Africa.
有效的生物医学和结构性艾滋病毒预防方法正在撒哈拉以南非洲各地实施。艾滋病毒预防的“生命周期方法”认识到妇女、儿童和青少年健康之间的相互联系，并优先考虑对这些人群有益的干预措施。我们回顾了针对妇女、青少年和儿童的新生物医学预防策略、结构性预防方法以及消除婴儿艾滋病毒感染的新模式，并讨论了生命周期方法对这些方法成功实施的影响。生命周期方法的一些例子包括评估少女的教育和艾滋病毒预防策略，不仅要考虑其在降低艾滋病毒感染风险和早孕方面的作用，还要促进青少年健康，使其未来生育更健康的孩子。同样，诸如纯母乳喂养等幼儿期干预措施不仅能预防艾滋病毒，还有助于改善儿童和青少年的健康状况。最雄心勃勃的生物医学婴儿艾滋病毒预防措施“B+方案”，通过利用为母亲提供最佳艾滋病毒治疗的预防益处，也体现了一种生命周期方法；“B+方案”带来的孕产妇生存益处，可能最终对儿童的健康影响比单独预防婴儿艾滋病毒更大。在撒哈拉以南非洲扩大艾滋病毒预防工作时，应考虑生命周期干预措施产生协同增效和叠加效益的可能性。
