Card Kiffer G, Lachowsky Nathan J, Althoff Keri N, Schafer Katherine, Hogg Robert S, Montaner Julio S G
Faculty of Health Science, Simon Fraser University, Burnaby, British Columbia, Canada.
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
Sex Health. 2019 Feb;16(1):1-17. doi: 10.1071/SH18104.
Background With the emergence of antiretroviral therapy (ART), Treatment as Prevention (TasP) has become the cornerstone of both HIV clinical care and HIV prevention. However, despite the efficacy of treatment-based programs and policies, structural barriers to ART initiation, adherence and viral suppression have the potential to reduce TasP effectiveness. These barriers have been studied using Geographic Information Systems (GIS). While previous reviews have examined the use of GIS for HIV testing - an essential antecedent to clinical care - to date, no reviews have summarised the research with respect to other ART-related outcomes.
Therefore, the present review leveraged the PubMed database to identify studies that leveraged GIS to examine the barriers to ART initiation, adherence and viral suppression, with the overall goal of understanding how GIS has been used (and might continue to be used) to better study TasP outcomes. Joanna Briggs Institute criteria were used for the critical appraisal of included studies.
In total, 33 relevant studies were identified, excluding those not utilising explicit GIS methodology or not examining TasP-related outcomes.
Findings highlight geospatial variation in ART success and inequitable distribution of HIV care in racially segregated, economically disadvantaged, and, by some accounts, increasingly rural areas - particularly in the United States. Furthermore, this review highlights the utility and current limitations of using GIS to monitor health outcomes related to ART and the need for careful planning of resources with respect to the geospatial movement and location of people living with HIV (PLWH).
背景 随着抗逆转录病毒疗法（ART）的出现，治疗即预防（TasP）已成为HIV临床护理和HIV预防的基石。然而，尽管基于治疗的项目和政策具有有效性，但ART启动、依从性和病毒抑制方面的结构性障碍有可能降低TasP的有效性。这些障碍已通过地理信息系统（GIS）进行研究。虽然之前的综述研究了GIS在HIV检测（临床护理的重要前提）中的应用，但迄今为止，尚无综述总结关于其他与ART相关结果的研究。
因此，本综述利用PubMed数据库来识别利用GIS研究ART启动、依从性和病毒抑制障碍的研究，总体目标是了解GIS如何被用于（以及可能继续被用于）更好地研究TasP结果。纳入研究的批判性评价采用乔安娜·布里格斯研究所的标准。
总共识别出33项相关研究，排除了那些未使用明确的GIS方法或未研究与TasP相关结果的研究。
研究结果突出了ART成功方面的地理空间差异以及HIV护理在种族隔离、经济弱势且在某些人看来日益农村化的地区（尤其是在美国）的不公平分布。此外，本综述强调了使用GIS监测与ART相关健康结果的效用和当前局限性，以及针对HIV感染者（PLWH）的地理空间流动和位置进行资源精心规划的必要性。
