Yendewa George A, Poveda Eva, Yendewa Sahr A, Sahr Foday, Quiñones-Mateu Miguel E, Salata Robert A
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
AIDS Rev. 2018 Apr-Jun;20(2):104-113. doi: 10.24875/AIDSRev.M18000022.
Sierra Leone is a low-income West African country that has dealt with waves of economic, political, and public health challenges in its recent past, including a decade-long brutal civil war and the Ebola epidemic of 2014-2016. The HIV/AIDS epidemic, which has raged on in the country since 1987, has long been characterized as stable. The latest UNAIDS report estimates a countrywide HIV prevalence rate of 1.7% in 2016 among adults aged 15-49 years. However, there are indications that the epidemic may be in fact escalating and unless arrested urgently, has the potential to deteriorate into a major public health emergency. Although there are high levels of HIV awareness among adults (over 94%), uptake in voluntary HIV testing has remained low (<30%), and under one-third (29%) of the country's 60,000 people living with HIV/AIDS were on antiretroviral therapy in 2015. This review attempts to address the paucity of scientific information on the subject by presenting the historical and epidemiological background to the HIV/AIDS epidemic in Sierra Leone. Other aspects of the HIV/AIDS epidemic in Sierra Leone are examined, including routine HIV screening and diagnosis, linkage to and retention in HIV care, clinical characteristics and molecular epidemiology, treatment coverage, and prevention strategies. Finally, we identify four key areas of challenge that are hampering current efforts attempting to bring the epidemic under control, and perspective is offered on the way forward.
塞拉利昂是西非的一个低收入国家，该国近期经历了多轮经济、政治和公共卫生挑战，包括长达十年的残酷内战以及2014 - 2016年的埃博拉疫情。自1987年以来肆虐该国的艾滋病毒/艾滋病疫情长期以来一直被认为处于稳定状态。联合国艾滋病规划署的最新报告估计，2016年该国15至49岁成年人中的艾滋病毒流行率为1.7%。然而，有迹象表明疫情实际上可能正在升级，除非紧急遏制，否则有可能恶化为重大公共卫生紧急事件。尽管成年人对艾滋病毒的知晓率很高（超过94%），但自愿艾滋病毒检测的接受率仍然很低（<30%），2015年该国6万名艾滋病毒/艾滋病感染者中接受抗逆转录病毒治疗的不到三分之一（29%）。本综述试图通过介绍塞拉利昂艾滋病毒/艾滋病疫情的历史和流行病学背景来弥补该主题科学信息的匮乏。文中还探讨了塞拉利昂艾滋病毒/艾滋病疫情的其他方面，包括常规艾滋病毒筛查与诊断、艾滋病毒治疗的衔接与留存、临床特征与分子流行病学、治疗覆盖率以及预防策略。最后，我们确定了阻碍当前控制疫情努力的四个关键挑战领域，并对未来的方向提出了展望。
