BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
J Int AIDS Soc. 2017 Sep 19;20(1):21941. doi: 10.7448/IAS.20.1.21941.
British Columbia has made significant progress in the treatment and prevention of HIV since 1996, when Highly Active Antiretroviral Therapy (HAART) became available. However, we currently lack a historical summary of HIV prevention and care interventions implemented in the province since the introduction of HAART and how they have shaped the HIV epidemic. Guided by a socio-ecological framework, we present a historical review of biomedical and health services, community and structural interventions implemented in British Columbia from 1996-2015 to prevent HIV transmission or otherwise enhance the cascade of HIV care.
We constructed a historical timeline of HIV interventions implemented in BC between 1996 and 2015 by reviewing publicly available reports, guidelines and other documents from provincial health agencies, community organizations and AIDS service organizations, and by conducting searches of peer-reviewed literature through PubMed and Ovid MEDLINE. We collected further programmatic information by administering a data collection form to representatives from BC's regional health authorities and an umbrella agency representing 45 AIDS Service organizations. Using linked population-level health administrative data, we identified key phases of the HIV epidemic in British Columbia, as characterized by distinct changes in HIV incidence, HAART uptake and the provincial HIV response.
In total, we identified 175 HIV prevention and care interventions implemented in BC from 1996 to 2015. We identify and describe four phases in BC's response to HIV/AIDS: the early HAART phase (1996-1999); the harm reduction and health service scale-up phase (2000-2005); the early Treatment as Prevention phase (2006-2009); and the STOP HIV/AIDS phase (2010-present). In doing so, we provide an overview of British Columbia's universal and centralized HIV treatment system and detail the role of community-based and provincial stakeholders in advancing innovative prevention and harm reduction approaches, as well as "seek, test, treat and retain" strategies.
The review provides valuable insight into British Columbia's HIV response, highlights emerging priorities, and may inform future efforts to evaluate the causal impact of interventions.
自 1996 年高效抗逆转录病毒疗法（HAART）问世以来，不列颠哥伦比亚省在艾滋病毒的治疗和预防方面取得了重大进展。然而，我们目前缺乏自 HAART 引入以来在该省实施的艾滋病毒预防和护理干预措施的历史总结，以及它们如何影响艾滋病毒流行。本研究以社会生态学框架为指导，回顾了 1996 年至 2015 年不列颠哥伦比亚省实施的生物医学和卫生服务、社区和结构干预措施，以防止艾滋病毒传播或增强艾滋病毒护理的传播。
我们通过查阅省级卫生机构、社区组织和艾滋病服务组织提供的公开报告、指南和其他文件，以及通过 PubMed 和 Ovid MEDLINE 对同行评议文献进行搜索，构建了 1996 年至 2015 年不列颠哥伦比亚省实施的艾滋病毒干预措施的历史时间表。我们通过向不列颠哥伦比亚省地区卫生当局和代表 45 个艾滋病服务组织的伞式机构的代表发放数据收集表，收集了进一步的项目信息。利用关联的人群健康管理数据，我们确定了不列颠哥伦比亚省艾滋病毒流行的关键阶段，其特征是艾滋病毒发病率、HAART 使用率和省级艾滋病毒应对措施的显著变化。
共确定了 1996 年至 2015 年在不列颠哥伦比亚省实施的 175 项艾滋病毒预防和护理干预措施。我们确定并描述了不列颠哥伦比亚省对艾滋病毒/艾滋病的四种反应阶段：早期 HAART 阶段（1996-1999 年）；减少危害和扩大卫生服务阶段（2000-2005 年）；早期治疗即预防阶段（2006-2009 年）；以及“停止艾滋病毒/艾滋病”阶段（2010 年至今）。这样做的同时，我们概述了不列颠哥伦比亚省的普遍和集中的艾滋病毒治疗系统，并详细介绍了社区和省级利益攸关方在推进创新的预防和减少危害方法以及“发现、检测、治疗和保留”战略方面的作用。
该综述提供了不列颠哥伦比亚省艾滋病毒应对措施的宝贵见解，突出了新出现的重点，并可能为评估干预措施的因果影响提供未来努力的信息。
