男男性行为者中减少HIV-1传播及相关成本的性伴通知：一项数学建模研究
Partner Notification for Reduction of HIV-1 Transmission and Related Costs among Men Who Have Sex with Men: A Mathematical Modeling Study.
作者信息
Nichols Brooke E, Götz Hannelore M, van Gorp Eric C M, Verbon Annelies, Rokx Casper, Boucher Charles A B, van de Vijver David A M C
机构信息
Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands.
Department Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands.
出版信息
PLoS One. 2015 Nov 10;10(11):e0142576. doi: 10.1371/journal.pone.0142576. eCollection 2015.
BACKGROUND
Earlier antiretroviral treatment initiation prevents new HIV infections. A key problem in HIV prevention and care is the high number of patients diagnosed late, as these undiagnosed patients can continue forward HIV transmission. We modeled the impact on the Dutch men-who-have-sex-with-men (MSM) HIV epidemic and cost-effectiveness of an existing partner notification process for earlier identification of HIV-infected individuals to reduce HIV transmission.
METHODS
Reduction in new infections and cost-effectiveness ratios were obtained for the use of partner notification to identify 5% of all new diagnoses (Scenario 1) and 20% of all new diagnoses (Scenario 2), versus no partner notification. Costs and quality adjusted life years (QALYs) were assigned to each disease state and calculated over 5 year increments for a 20 year period.
RESULTS
Partner notification is predicted to avert 18-69 infections (interquartile range [IQR] 13-24; 51-93) over the course of 5 years countrywide to 221-830 (IQR 140-299; 530-1,127) over 20 years for Scenario 1 and 2 respectively. Partner notification was considered cost-effective in the short term, with increasing cost-effectiveness over time: from €41,476 -€41, 736 (IQR €40,529-€42,147; €40,791-€42,397) to €5,773 -€5,887 (€5,134-€7,196; €5,411-€6,552) per QALY gained over a 5 and 20 year period, respectively. The full monetary benefits of partner notification by preventing new HIV infections become more apparent over time.
CONCLUSIONS
Partner notification will not lead to the end of the HIV epidemic, but will prevent new infections and be increasingly cost-effectiveness over time.
背景
尽早开始抗逆转录病毒治疗可预防新发艾滋病毒感染。艾滋病毒预防和护理中的一个关键问题是大量患者诊断延迟，因为这些未被诊断的患者会继续传播艾滋病毒。我们模拟了对荷兰男男性行为者（MSM）艾滋病毒疫情的影响，以及现有伴侣通知程序对早期识别艾滋病毒感染者以减少艾滋病毒传播的成本效益。
方法
与不进行伴侣通知相比，使用伴侣通知识别所有新诊断病例的5%（方案1）和20%（方案2），得出新感染减少情况和成本效益比。为每种疾病状态分配成本和质量调整生命年（QALY），并在20年期间按5年增量进行计算。
结果
预计在全国范围内，伴侣通知在5年内可避免18 - 69例感染（四分位间距[IQR]为13 - 24；51 - 93），在20年内分别为221 - 830例（IQR为140 - 299；53０ - 1,127），方案1和方案2情况分别如此。伴侣通知在短期内被认为具有成本效益，且随着时间推移成本效益增加：在5年和20年期间，每获得一个QALY分别从41,476欧元 - 41,736欧元（IQR为40,529欧元 - 42,147欧元；40,791欧元 - 42,397欧元）降至5,773欧元 - 5,887欧元（5,134欧元 - 7,196欧元；5,411欧元 - 6,552欧元）。通过预防新发艾滋病毒感染，伴侣通知的全部货币效益随着时间推移变得更加明显。
结论
伴侣通知不会导致艾滋病毒疫情结束，但会预防新感染，且随着时间推移成本效益会越来越高。
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