Low-Beer Daniel, Beusenberg Michel, Hayashi Chika, Calleja Txema, Marsh Kimberly, Mamahit Awandha, Babovic Theresa, Hirnschall Gottfried
HIV Department, WHO, Geneva, Switzerland.
UNAIDS, Geneva, Switzerland.
AIDS Behav. 2017 Jul;21(Suppl 1):15-22. doi: 10.1007/s10461-017-1754-1.
Although not originally part of the MDGs, HIV treatment has been at the center of global HIV reporting since 2003, marked by achievement of the target of 15 million people receiving treatment before 2015 and 18.2 million (16.1-19.0 million) by mid 2016. Monitoring of treatment has been strengthened with harmonized partner reporting and accountability with regular, annual reports. Beyond treatment numbers, increasingly measures of treatment adherence, retention and outcomes have been reported though with varying quality and completeness. However, with the sustainable development goals (SDGs), monitoring treatment is changing in three important ways. First, treatment monitoring is shifting from numbers to coverage and gaps in a cascade of services to achieve universal access. Secondly, this requires greater emphasis on disaggregated, individual level patient and case monitoring systems, which can better support linkage, retention and chronic, long term care. Thirdly, the prevention, testing and treatment cascade with a clear results chain, links treatment numbers to impact, in terms of reduced viral load, mortality and incidence. This agenda will require a greater contribution of routine impact evaluation alongside monitoring, with treatment seen as part of a cascade of services to ensure impact on mortality and incidence. In conclusion, the shift from monitoring treatment numbers to treatment linked to universal access to prevention, testing and treatment and impact on mortality and incidence, will be critical to monitor, evaluate, and improve HIV programs as part of the SDGs.
尽管最初并非千年发展目标的一部分，但自2003年以来，艾滋病毒治疗一直是全球艾滋病毒报告的核心内容，其标志是在2015年前实现了1500万人接受治疗的目标，到2016年年中这一数字达到1820万（1610万至1900万）。通过统一伙伴报告以及定期年度报告的问责制，治疗监测得到了加强。除了治疗人数外，越来越多关于治疗依从性、留存率和治疗效果的指标也得到了报告，不过报告的质量和完整性参差不齐。然而，随着可持续发展目标（SDGs）的提出，治疗监测正在三个重要方面发生变化。首先，治疗监测正从关注人数转向关注一系列服务中的覆盖情况和差距，以实现普遍可及。其次，这需要更加强调分类的、个体层面的患者和病例监测系统，该系统能够更好地支持衔接、留存以及长期的慢性护理。第三，具有明确结果链的预防、检测和治疗级联，将治疗人数与病毒载量降低、死亡率和发病率方面的影响联系起来。这一议程将要求在监测之外，常规影响评估做出更大贡献，将治疗视为一系列服务的一部分，以确保对死亡率和发病率产生影响。总之，从监测治疗人数转向监测与预防、检测和治疗的普遍可及以及对死亡率和发病率的影响相关联的治疗，对于作为可持续发展目标一部分的艾滋病毒项目的监测、评估和改进至关重要。
