Cranston Kevin, John Betsey, Fukuda H Dawn, Randall Liisa M, Mermin Jonathan, Mayer Kenneth H, DeMaria Alfred
Kevin Cranston, Betsey John, H. Dawn Fukuda, Liisa M. Randall, and Alfred DeMaria Jr are with Massachusetts Department of Public Health, Boston. Jonathan Mermin is with Centers for Disease Control and Prevention, Atlanta, GA. Kenneth H. Mayer is with The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
Am J Public Health. 2017 May;107(5):794-799. doi: 10.2105/AJPH.2017.303697.
To describe secular trends in reported HIV diagnoses in Massachusetts concurrent with treatment access expansion.
We characterized cases of HIV infection reported to the Massachusetts HIV/AIDS Surveillance Program between 2000 and 2014 by sex, age, race/ethnicity, and exposure mode. We used Poisson regression to test the statistical significance of trends in diagnoses.
Between 2000 and 2014, annual new HIV infections diagnosed in Massachusetts decreased by 47% (P < .001 for trend). We observed significant reductions in diagnoses among women (58% when comparing 2000 with 2014), men (42%), Whites (54%), Blacks (51%), and Hispanics (35%; P < .001 for trend). New diagnoses decreased significantly among men who have sex with men (19%), persons who inject drugs (91%), and heterosexuals (86%; P < .001 for trend). We saw statistically significant downward trends among all men by race/ethnicity, but the trend among Black men who have sex with men was nonsignificant.
Sustained reduction in new HIV diagnoses was concurrent with Massachusetts's Medicaid expansion, state health care reform, and public health strategies to improve care access. A contributory effect of expanded HIV treatment and population-level viral suppression is hypothesized for future research.
描述马萨诸塞州报告的艾滋病病毒（HIV）诊断的长期趋势，同时观察治疗可及性的扩大情况。
我们对2000年至2014年期间向马萨诸塞州HIV/艾滋病监测项目报告的HIV感染病例，按性别、年龄、种族/族裔和暴露方式进行了特征描述。我们使用泊松回归检验诊断趋势的统计学显著性。
2000年至2014年期间，马萨诸塞州每年新诊断出的HIV感染病例减少了47%（趋势P < .001）。我们观察到女性（2000年与2014年相比下降58%）、男性（42%）、白人（54%）、黑人（51%）和西班牙裔（35%；趋势P < .001）的诊断显著减少。男男性行为者（19%）、注射毒品者（91%）和异性恋者（86%）的新诊断显著下降（趋势P < .001）。我们发现按种族/族裔划分的所有男性中均有统计学显著的下降趋势，但男男性行为的黑人男性中的趋势不显著。
新HIV诊断的持续减少与马萨诸塞州医疗补助计划的扩大、州医疗保健改革以及改善医疗可及性的公共卫生策略同时发生。推测扩大HIV治疗和人群水平的病毒抑制有促成作用，有待未来研究。
