MMWR Morb Mortal Wkly Rep. 2018 Jun 15;67(23):663-667. doi: 10.15585/mmwr.mm6723a3.
To achieve epidemic control of human immunodeficiency virus (HIV) infection, sub-Saharan African countries are striving to diagnose 90% of HIV infections, initiate and retain 90% of HIV-diagnosed persons on antiretroviral therapy (ART), and achieve viral load suppression* for 90% of ART recipients (90-90-90) (1). In Eswatini (formerly Swaziland), the country with the world's highest estimated HIV prevalence (27.2%), achieving 90-90-90 depends upon improving access to early ART for men and young adults with HIV infection, two groups with low ART coverage (1-3). Although community-based strategies test many men and young adults with HIV infection in Eswatini, fewer than one third of all persons who test positive in community settings enroll in HIV care within 6 months of diagnosis after receiving standard referral services (4,5). To evaluate the effectiveness of peer-delivered linkage case management in improving early ART initiation for persons with HIV infection diagnosed in community settings in Eswatini, CDC analyzed data on 651 participants in CommLink, a community-based, mobile HIV-testing, point-of-diagnosis HIV care, and peer-delivered linkage case management demonstration project, and found that after diagnosis, 635 (98%) enrolled in care within a median of 5 days (interquartile range [IQR] = 2-8 days), and 541 (83%) initiated ART within a median of 6 days (IQR = 2-14 days), including 402 (74%) on the day of their first clinic visit (same-day ART). After expanding ART eligibility to all persons with HIV infection on October 1, 2016, 96% of 225 CommLink clients initiated ART, including 87% at their first clinic visit. Compared with women and adult clients aged ≥30 years, similar high proportions of men and persons aged 15-29 years enrolled in HIV care and received same-day ART. To help achieve 90-90-90 by 2020, the United States President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the national scale-up of CommLink in Eswatini and recommending peer-delivered linkage case management as a potential strategy for countries to achieve >90% early enrollment in care and ART initiation after diagnosis of HIV infection (6).
为了实现人类免疫缺陷病毒（HIV）感染的流行控制，撒哈拉以南非洲国家正在努力实现以下目标：诊断 90%的 HIV 感染，启动并维持 90%的 HIV 诊断患者接受抗逆转录病毒治疗（ART），并使 90%接受 ART 的患者实现病毒载量抑制*（90-90-90）（1）。在斯威士兰（前身为斯威士兰），该国是世界上 HIV 流行率最高的国家（27.2%），要实现 90-90-90 的目标，取决于改善对男性和年轻成年人中 HIV 感染者的早期 ART 治疗，这两个群体的 ART 覆盖率较低（1-3）。尽管斯威士兰的社区为许多 HIV 感染者提供了检测服务，但在社区环境中接受检测呈阳性的不到三分之一的人在接受标准转介服务后 6 个月内登记接受 HIV 护理（4，5）。为了评估同伴提供的联系病例管理在改善社区环境中 HIV 感染者早期接受 ART 治疗方面的有效性，CDC 分析了参与 CommLink 的 651 名参与者的数据，CommLink 是一个社区为基础、移动 HIV 检测、诊断时即提供 HIV 护理和同伴提供的联系病例管理示范项目，发现诊断后，中位数为 5 天（四分位距 [IQR] = 2-8 天）内有 635 人（98%）登记接受护理，中位数为 6 天（IQR = 2-14 天）内有 541 人（83%）开始接受 ART，包括 402 人（74%）在首次就诊当天（即开始 ART）。2016 年 10 月 1 日扩大了对所有 HIV 感染者的 ART 资格后，225 名 CommLink 客户中有 96%开始接受 ART，其中 87%在首次就诊时开始接受 ART。与年龄≥30 岁的妇女和成年患者相比，相似比例的男性和 15-29 岁的患者登记接受 HIV 护理并接受了当天的 ART。为了在 2020 年之前实现 90-90-90 的目标，美国总统艾滋病紧急救援计划（PEPFAR）正在支持斯威士兰全国范围扩大 CommLink，并建议同伴提供的联系病例管理作为各国实现>90%的 HIV 感染诊断后早期接受护理和 ART 治疗的潜在策略（6）。
