Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Epicentre AIDS Risk Management (Pty) Limited, Paarl, South Africa.
Lancet HIV. 2017 Nov;4(11):e505-e513. doi: 10.1016/S2352-3018(17)30122-4. Epub 2017 Aug 2.
BACKGROUND: With the goal of eliminating new HIV infections, UNAIDS set the ambitious 90-90-90 targets to be achieved by 2020. We assessed whether these targets are being met among participants of the HIV Incidence Provincial Surveillance System (HIPSS) in a high-burden district of South Africa. METHODS: We used data from a HIPSS household-based, cross-sectional survey of HIV prevalence and incidence done in the uMgungundlovu district, KwaZulu-Natal, in 2014 and 2015. In randomly selected enumeration areas, 50 households were drawn systematically along a serpentine pattern from a random start point. One eligible individual in each household was asked to provide blood for HIV testing and to complete a questionnaire. If a household refused to participate, the house next to it was approached. Eligible participants were aged 15-49 years, lived in the household, were not planning to move away, and spoke English or Zulu. Viral load was measured in samples positive for HIV. We also assessed participants' HIV linkage to care and treatment. Data were population weighted to allow for multilevel sampling and non-response. FINDINGS: 9812 participants were enrolled, 3547 men (36%) and 6265 women (64%). Overall, 504 of 1014 men (estimate 52%, 95% CI 47-56) and 1833 of 2955 women (65%, 62-67) who were HIV positive knew their HIV status. Of those who knew, 344 of 522 men (69%, 63-75) and 1254 of 1845 women (70%, 68-73) were taking ART. Among recipients of ART, 294 of 341 men (85%, 80-90) and 1117 of 1249 women (90%, 87-92) had viral loads less than 1000 copies per mL. Among all HIV-positive participants, 427 of 1014 men (44%, 39-49) and 1680 of 2955 women (58%, 55-61) had viral loads lower than 1000 copies per mL. INTERPRETATION: No UNAIDS 90-90-90 targets had been met in our study population. Major campaigns are needed to increase HIV testing, especially among men, and to ensure all HIV-positive patients are taking ART. FUNDING: Centers for Disease Control and Prevention and the US Presidents Emergency Plan for AIDS Relief (PEPFAR).
背景：为了消除新的 HIV 感染，联合国艾滋病规划署设定了雄心勃勃的 90-90-90 目标，希望在 2020 年实现。我们评估了在南非一个高负担地区的 HIV 发病率省级监测系统（HIPSS）参与者中这些目标的实现情况。
方法：我们使用了 2014 年至 2015 年在夸祖鲁-纳塔尔省乌姆古伦多洛区进行的基于家庭的 HIV 患病率和发病率的 HIPSS 横断面调查的数据。在随机选择的普查区，系统地沿着一条蛇形图案从一个随机起点抽取 50 户。每个家庭中符合条件的一个人被要求提供血液进行 HIV 检测并填写一份问卷。如果一个家庭拒绝参与，就会去拜访隔壁的家庭。符合条件的参与者年龄在 15-49 岁之间，居住在家庭中，不打算离开，会说英语或祖鲁语。病毒载量在 HIV 阳性样本中进行测量。我们还评估了参与者与护理和治疗的 HIV 关联。数据进行了人口加权，以便进行多层次抽样和非响应。
结果：共纳入 9812 名参与者，其中男性 3547 名（36%），女性 6265 名（64%）。总体而言，1014 名男性中有 504 名（估计为 52%，95%CI 47-56）和 2955 名女性中有 1833 名（65%，62-67）知道自己的 HIV 状况。在知情者中，522 名男性中有 344 名（69%，63-75）和 1845 名女性中有 1254 名（70%，68-73）正在接受抗逆转录病毒治疗。在接受抗逆转录病毒治疗的患者中，341 名男性中有 294 名（85%，80-90）和 1249 名女性中有 1117 名（90%，87-92）病毒载量小于 1000 拷贝/ml。在所有 HIV 阳性参与者中，1014 名男性中有 427 名（44%，39-49）和 2955 名女性中有 1680 名（58%，55-61）病毒载量低于 1000 拷贝/ml。
解释：在我们的研究人群中，没有达到联合国艾滋病规划署的 90-90-90 目标。需要开展重大运动，以增加 HIV 检测，尤其是在男性中，并确保所有 HIV 阳性患者都接受抗逆转录病毒治疗。
资金来源：疾病控制和预防中心以及美国总统艾滋病紧急救援计划（PEPFAR）。
BMC Public Health. 2020-9-9
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