美国国家艾滋病毒/艾滋病战略目标对改善艾滋病毒护理参与的影响：建模研究。
Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study.
机构信息
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, MD, USA.
出版信息
Lancet HIV. 2016 Mar;3(3):e140-6. doi: 10.1016/S2352-3018(16)00007-2. Epub 2016 Feb 8.
BACKGROUND
The recently updated White House National HIV/AIDS Strategy (NHAS) includes specific progress indicators to improve the HIV care continuum in the USA, but the economic and epidemiological effect of achieving those indicators remains unclear. We aimed to project the impact of achieving NHAS goals on HIV incidence, prevalence, mortality, and costs among adults in the USA over 10 years.
METHODS
We constructed a dynamic transmission model of HIV progression and care engagement based on literature sources and the most recent published US Centers for Disease Control and Prevention data. We specifically considered achievement of the 2020 targets set forth in NHAS progress indicator 1 (90% awareness of serostatus), indicator 4 (85% linkage within 1 month), and indicator 5 (90% of diagnosed individuals in care).
FINDINGS
At current rates of engagement in the HIV care continuum, we project 524,000 (95% uncertainty range 442,000-712,000) new HIV infections and 375,000 deaths (364,000-578,000) between 2016 and 2025. Achievement of NHAS progress indicators 1 and 4 has modest epidemiological effect (new infections reduced by 2·0% and 3·9%, respectively). By contrast, increasing the proportion of diagnosed individuals in care (NHAS indicator 5) averts 52% (95% UR 47-56) of new infections. Achievement of all NHAS targets resulted in a 58% reduction (95% UR 52-61) in new infections and 128 000 lives saved (106,000-223,000) at an incremental health system cost of US$105 billion.
INTERPRETATION
Achievement of NHAS progress indicators for screening, linkage, and particularly improving retention in care, can substantially reduce the burden of HIV in the USA, but continued and increased financial investment will be required.
FUNDING
The National Institutes of Health, the B Frank and Kathleen Polk Assistant Professorship in Epidemiology, Emory University CFAR, Johns Hopkins University CFAR, and CDC/NCHHSTP Epidemiological and Economic Modeling Agreement (5U38PS004646).
背景
最近更新的白宫国家艾滋病病毒/艾滋病战略（NHAS）包括具体的进展指标，以改善美国的艾滋病毒护理连续体，但实现这些指标的经济和流行病学影响仍不清楚。我们的目的是预测在未来 10 年内实现 NHAS 目标对美国成年人的艾滋病毒发病率、流行率、死亡率和成本的影响。
方法
我们根据文献来源和美国疾病控制与预防中心最近公布的数据，构建了一个艾滋病毒进展和护理参与的动态传播模型。我们特别考虑了 NHAS 进展指标 1（90%的知晓血清状况）、指标 4（85%的在 1 个月内联系）和指标 5（90%的诊断个体在护理中）所设定的 2020 年目标的实现情况。
结果
以目前在艾滋病毒护理连续体中的参与率，我们预计在 2016 年至 2025 年期间将有 524,000 例（95%不确定性范围为 442,000-712,000）新的艾滋病毒感染和 375,000 人死亡（364,000-578,000）。实现 NHAS 进展指标 1 和 4 具有适度的流行病学影响（新感染分别减少 2.0%和 3.9%）。相比之下，增加诊断个体在护理中的比例（NHAS 指标 5）可避免 52%（95% UR 47-56）的新感染。实现所有 NHAS 目标可使新感染减少 58%（95% UR 52-61），并挽救 128,000 人生命（106,000-223,000），卫生系统的额外成本为 1050 亿美元。
解释
实现 NHAS 筛查、联系和特别是改善护理保留方面的进展指标，可以大大减轻美国的艾滋病毒负担，但需要持续和增加财政投资。
资助
美国国立卫生研究院、弗兰克和凯瑟琳·波尔克教授在流行病学、埃默里大学 CFAR、约翰霍普金斯大学 CFAR 和疾病预防控制中心/NCHHSTP 流行病学和经济建模协议（5U38PS004646）的资助。
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