Lesko Catherine R, Sampson Lynne A, Miller William C, Clymore Jacquelyn, Leone Peter A, Swygard Heidi, Powers Kimberly A
*Department of Epidemiology, University of North Carolina, Chapel Hill, NC; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Department of Medicine, University of North Carolina, Chapel Hill, NC; and §Communicable Disease Branch, North Carolina Division of Public Health, Raleigh, NC.
J Acquir Immune Defic Syndr. 2015 Dec 15;70(5):489-94. doi: 10.1097/QAI.0000000000000788.
The HIV care continuum is a critical framework for situational awareness of the HIV epidemic; yet challenges to accurate enumeration of continuum components hamper continuum estimation in practice. We describe local surveillance-based estimation of the HIV continuum in the United States, reviewing common practices as recommended by the Centers for Disease Control and Prevention. Furthermore, we review some challenges and biases likely to threaten existing continuum estimates. Current estimates rely heavily on the use of CD4 cell count and HIV viral load laboratory results reported to surveillance programs as a proxy for receipt of HIV-related outpatient care. As such, continuum estimates are susceptible to bias because of incomplete laboratory reporting and imperfect sensitivity and specificity of laboratory tests as a proxy for routine HIV care. Migration of HIV-infected persons between jurisdictions also threatens the validity of continuum estimates. Data triangulation may improve but not fully alleviate biases.
艾滋病毒照护连续统是了解艾滋病毒疫情态势的关键框架；然而，准确枚举连续统各组成部分面临的挑战阻碍了实际中的连续统估算。我们描述了美国基于本地监测的艾滋病毒连续统估算方法，回顾了疾病控制与预防中心推荐的常见做法。此外，我们还审视了一些可能威胁现有连续统估算结果的挑战和偏差。当前的估算严重依赖向监测项目报告的CD4细胞计数和艾滋病毒病毒载量实验室结果，以此作为接受艾滋病毒相关门诊护理的替代指标。因此，由于实验室报告不完整以及实验室检测作为常规艾滋病毒护理替代指标的敏感性和特异性不完善，连续统估算容易出现偏差。艾滋病毒感染者在不同辖区之间的流动也威胁着连续统估算的有效性。数据三角测量法可能会改善但无法完全消除偏差。
