The Ohio State University, Columbus, OH, USA.
Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.
J Int AIDS Soc. 2019 Jan;22(1):e25218. doi: 10.1002/jia2.25218.
"Treat All" - the treatment of all people with HIV, irrespective of disease stage or CD4 cell count - represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub-Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation.
The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision-makers, and HIV community representatives in East, Central, Southern and West Africa.
The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders - groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub-national estimates of the size of key populations and describe those who remain underserved along the HIV-care continuum; (2) characterize the timeliness of HIV care and short- and long-term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV-drug resistance and regimen switching; and (4) identify cost-effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV-care continuum, particularly among underserved populations.
Reflecting consensus among a broad group of experts, researchers, policy- and decision-makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.
“全面治疗”——即对所有艾滋病毒感染者进行治疗，无论其疾病阶段或 CD4 细胞计数如何——这代表了艾滋病毒治疗方面的一个范式转变，有可能终结艾滋病对公共卫生的威胁。随着撒哈拉以南非洲（SSA）加速实施“全面治疗”，需要制定一个重点议程和研究计划，以确定和告知促进及时接受艾滋病毒治疗、在治疗中保持连续性以及持续病毒抑制的战略，并解决阻碍实施的瓶颈问题。
采用德尔菲法就 SSA 中“全面治疗”实施的研究重点达成共识。通过一个迭代过程（2017 年 6 月至 2018 年 3 月），由一个技术工作组共同制定了一系列研究重点，并分发给 200 多名来自东非、中非、南非和西非的研究人员、实施专家、政策/决策者和艾滋病毒社区代表，供其审查、审议和优先排序。
这一过程产生了一系列 9 项研究重点，旨在为指导“全面治疗”政策、实施策略和监测工作提供证据。这些重点强调需要更加关注青少年、男性以及患有精神健康和药物使用障碍的人群，这些人群在 SSA 中仍得不到充分服务，需要确定更有效的检测、关联和护理策略。这些重点还反映了就以下方面达成的共识：（1）生成准确的国家和次国家关键人群规模估计数，并描述艾滋病毒护理连续体中仍得不到充分服务的人群；（2）描述艾滋病毒护理的及时性以及短期和长期艾滋病毒护理连续体结果，以及影响及时实现这些结果的因素；（3）估计艾滋病毒耐药性和方案转换的发生率和流行率；（4）确定具有成本效益和负担得起的服务提供模式和战略，以优化接受度，并最大限度地减少艾滋病毒护理连续体中尤其是在得不到充分服务的人群中存在的差距、差异和损失。
这些研究重点反映了广泛的专家、研究人员、政策和决策者、PLWH 以及其他利益攸关方之间的共识，突出了与各国卫生部、供资机构、规范机构和研究网络相关的重要证据差距。
