评估在埃及血吸虫病高危社区大规模施用吡喹酮对预防艾滋病毒的潜在影响。
Evaluating the potential impact of mass praziquantel administration for HIV prevention in Schistosoma haematobium high-risk communities.
作者信息
Ndeffo Mbah Martial L, Gilbert Jennifer A, Galvani Alison P
机构信息
School of Public Health, Yale University, New Haven, CT, USA.
School of Public Health, Yale University, New Haven, CT, USA.
出版信息
Epidemics. 2014 Jun;7:22-7. doi: 10.1016/j.epidem.2014.04.002. Epub 2014 Apr 29.
Genital infection with Schistosoma haematobium is prevalent in sub-Saharan Africa. Epidemiological studies have observed that genital schistosomiasis is associated with an increased odd of HIV infection among women. We used mathematical modeling to explore the potential impact of mass preventive chemotherapy against schistosomiasis on HIV transmission in three sub-Saharan Africa countries: Angola, Kenya, and Zambia. We developed a model of female genital schistosomiasis (FGS) and HIV transmission dynamics, fitting it to data of HIV and S. haematobium prevalences as well as co-infection. We simulated targeted mass drug administration (MDA) with praziquantel to school-age children and mass treatment of the entire community. We estimated that, in S. haematobium high-risk communities, targeted annual treatment of school-age children could reduce HIV prevalence by 20% (95% CI: 12-31%) in Angola, 16% (95% CI: 10-32%) in Kenya, and 6% (95% CI: 3-18%) in Zambia after the first 20 years of intervention; and would reduce HIV incidence by 15% (95% CI: 13-32%) in Angola, 22% (95% CI: 18-42%) in Kenya, and 9% (95% CI: 3-22%) in Zambia. Extending the intervention to adults could reduce HIV prevalence by an additional 2.2% (95% CI: 0.2-12.0%) in Angola, 1.8% (95% CI: 0.1-5.2%) in Kenya, and 0.3% (95% CI: 0.1-2.1%) in Zambia; and would reduce HIV incidence by an additional 1.8% (95% CI: 0.0-14.4%) in Angola, 6.1% (95% CI: 0.5-12.6%) in Kenya, and 0.8% (95% CI: 0.0-2.7%) in Zambia. We showed that the exacerbation of HIV transmission due to FGS and the probability of developing FGS as a result of childhood infection with S. haematobium, were the most important factors in determining the effectiveness of praziquantel MDA for reducing HIV transmission. Praziquantel MDA may be an innovative measure for reducing schistosomiasis and HIV transmission in sub-Saharan Africa, the effectiveness of which varies with HIV prevalence.
埃及血吸虫引起的生殖器感染在撒哈拉以南非洲地区很普遍。流行病学研究观察到，女性生殖器血吸虫病与女性感染艾滋病毒的几率增加有关。我们使用数学模型来探索大规模预防性化疗防治血吸虫病对撒哈拉以南非洲三个国家（安哥拉、肯尼亚和赞比亚）艾滋病毒传播的潜在影响。我们建立了一个女性生殖器血吸虫病（FGS）和艾滋病毒传播动力学模型，并将其与艾滋病毒和埃及血吸虫流行率以及合并感染的数据进行拟合。我们模拟了对学龄儿童进行吡喹酮靶向大规模药物给药（MDA）以及对整个社区进行大规模治疗的情况。我们估计，在埃及血吸虫高风险社区，对学龄儿童进行年度靶向治疗，在干预的头20年后，可使安哥拉的艾滋病毒流行率降低20%（95%置信区间：12%-31%），肯尼亚降低16%（95%置信区间：10%-32%），赞比亚降低6%（95%置信区间：3%-18%）；并可使安哥拉的艾滋病毒发病率降低15%（95%置信区间：13%-32%），肯尼亚降低22%（95%置信区间：18%-42%），赞比亚降低9%（95%置信区间：3%-22%）。将干预措施扩展到成年人，可使安哥拉的艾滋病毒流行率再降低2.2%（95%置信区间：0.2%-12.0%），肯尼亚再降低1.8%（95%置信区间：0.1%-5.2%），赞比亚再降低0.3%（95%置信区间：0.1%-2.1%）；并可使安哥拉的艾滋病毒发病率再降低1.8%（95%置信区间：0.0%-14.4%），肯尼亚再降低6.1%（95%置信区间：0.5%-12.6%），赞比亚再降低0.8%（95%置信区间：0.0%-2.7%）。我们表明，FGS导致的艾滋病毒传播加剧以及儿童感染埃及血吸虫后发展为FGS的概率，是决定吡喹酮MDA降低艾滋病毒传播有效性的最重要因素。吡喹酮MDA可能是撒哈拉以南非洲减少血吸虫病和艾滋病毒传播的一项创新措施，其有效性因艾滋病毒流行率而异。
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