Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA.
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
J Int AIDS Soc. 2019 Jun;22(6):e25295. doi: 10.1002/jia2.25295.
INTRODUCTION: To achieve epidemic control of HIV by 2030, countries aim to meet 90-90-90 targets to increase knowledge of HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression by 2020. We assessed the progress towards these targets from 2014 to 2016 in South Africa as expanded treatment policies were introduced using population-representative surveys. METHODS: Data were collected in January to March 2014 and August to November 2016 in Dr. Ruth Segomotsi Mompati District, North West Province. Each multi-stage cluster sample included 46 enumeration areas (EA), a target of 36 dwelling units (DU) per EA, and a single resident aged 18 to 49 per DU. Data collection included behavioural surveys, rapid HIV antibody testing and dried blood spot collection. We used weighted general linear regression to evaluate differences in the HIV care continuum over time. RESULTS: Overall, 1044 and 971 participants enrolled in 2014 and 2016 respectively with approximately 77% undergoing HIV testing. Despite increases in reported testing, known status among people living with HIV (PLHIV) remained similar at 68.7% (95% Confidence Interval (CI) = 60.9-75.6) in 2014 and 72.8% (95% CI = 63.6-80.4) in 2016. Men were consistently less likely than women to know their status. Among those with known status, PLHIV on ART increased significantly from 80.9% (95% CI = 71.9-87.4) to 91.5% (95% CI = 84.4-95.5). Viral suppression (<5000 copies/mL using DBS) among those on ART increased significantly from 55.0% (95% CI = 39.6-70.4) in 2014 to 81.4% (95% CI = 72.0-90.8) in 2016. Among all PLHIV an estimated 72.0% (95% CI = 63.8-80.1) of women and 45.8% (95% CI = 27.0-64.7) of men achieved viral suppression by 2016. CONCLUSIONS: Over a period during which fixed-dose combination was introduced, ART eligibility expanded, and efforts to streamline treatment were implemented, major improvements in the second and third 90-90-90 targets were achieved. Achieving the first 90 target will require targeted and improved testing models for men.
简介：为了在 2030 年实现艾滋病毒流行控制，各国的目标是在 2020 年实现 90-90-90 目标，即提高艾滋病毒阳性检测率、开始抗逆转录病毒治疗 (ART) 和病毒抑制率。我们使用具有代表性的人群调查评估了 2014 年至 2016 年期间南非在扩大治疗政策方面在实现这些目标方面的进展情况。
方法：数据于 2014 年 1 月至 3 月和 2016 年 8 月至 11 月在西北省 Ruth Segomotsi Mompati 区收集。每个多阶段聚类样本包括 46 个计数区 (EA)，每个 EA 目标为 36 个居住单位 (DU)，每个 DU 有一名 18 至 49 岁的居民。数据收集包括行为调查、快速 HIV 抗体检测和干血斑采集。我们使用加权一般线性回归来评估随着时间的推移，艾滋病毒护理连续体的差异。
结果：总体而言，2014 年和 2016 年分别有 1044 名和 971 名参与者入组，约有 77%的人接受了 HIV 检测。尽管报告的检测次数有所增加，但艾滋病毒感染者 (PLHIV) 的已知状况仍保持相似，2014 年为 68.7%(95%置信区间[CI] = 60.9-75.6)，2016 年为 72.8%(95% CI = 63.6-80.4)。男性始终比女性更不可能了解自己的状况。在已知状况的人中，接受抗逆转录病毒治疗的 PLHIV 显著增加，从 2014 年的 80.9%(95% CI = 71.9-87.4)增加到 2016 年的 91.5%(95% CI = 84.4-95.5)。接受抗逆转录病毒治疗的人的病毒抑制率(<5000 拷贝/ml 用 DBS)从 2014 年的 55.0%(95% CI = 39.6-70.4)显著增加到 2016 年的 81.4%(95% CI = 72.0-90.8)。在所有 PLHIV 中，估计 2016 年女性中有 72.0%(95% CI = 63.8-80.1)，男性中有 45.8%(95% CI = 27.0-64.7)实现了病毒抑制。
结论：在引入固定剂量联合治疗、扩大 ART 资格和实施简化治疗措施的期间，第二和第三个 90-90-90 目标取得了重大进展。要实现第一个 90 目标，就需要针对男性进行有针对性和改进的检测模型。
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