Kempton Joe, Hill Andrew, Levi Jacob A, Heath Katherine, Pozniak Anton
Imperial College Healthcare NHS Trust, London, UK.
Liverpool School of Tropical Medicine, UK.
J Virus Erad. 2019 Apr 1;5(2):92-101. doi: 10.1016/S2055-6640(20)30058-3.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) targets aim to reduce new HIV infections below 500,000 per year by 2020. Despite targeted prevention programmes, total new infections remained in 2016 and 2017 at 1,800,000 cases. We have aimed to analyse data from 2017 and to compare HIV incidence, AIDS-related deaths and provision of antiretroviral therapy (ART) to adults, pregnant women and children living with HIV in lower- and higher-prevalence countries. Vertical or mother-to-child transmission (MTCT) and early infant diagnosis (EID) rates were also investigated.
UNAIDSinfo data use the Spectrum model to represent country-level HIV data. Countries with epidemics over 40,000 HIV cases were separated into higher prevalence (≥4.5%) and lower prevalence (<4.5%). Least squares linear regression, weighted by epidemic size and controlled for gross domestic product/capita, was used to compare HIV prevalence with estimated ART coverage in adults (≥15 years), children (0-14 years), pregnant women, and EID rates and MTCT rates. Data were then compared between higher- and lower-prevalence groups, including numbers of new HIV infections and AIDS-related deaths.
Data were available for 56 countries. Twelve higher-prevalence countries accounted for 16.7 million and 44 lower-prevalence ones for 15.1 million people living with HIV, altogether making up 87.5% of the global estimate. Lower-prevalence countries had less ART coverage for adults, pregnant women and children, lower EID rates and higher AIDS-related death levels. There were more new HIV infections in adults and children in lower- than higher-prevalence countries.
Most new HIV infections, MTCTs and AIDS-related deaths occurred in countries with an HIV prevalence rate below 4.5%. Many of these countries are not targeted by access programmes, such as the President' Emergency Plan for AIDS Relief. More intensive programmes of diagnosis and treatment are needed in these countries in the effort to reduce global new HIV infections below 500,000 per year by 2020.
联合国艾滋病规划署（UNAIDS）的目标是到2020年将每年新增艾滋病毒感染人数降至50万以下。尽管有针对性的预防计划，但2016年和2017年新增感染总数仍达180万例。我们旨在分析2017年的数据，并比较艾滋病毒发病率、与艾滋病相关的死亡情况，以及为艾滋病毒感染的成人、孕妇和儿童提供抗逆转录病毒疗法（ART）的情况。还调查了垂直传播或母婴传播（MTCT）以及早期婴儿诊断（EID）率。
UNAIDSinfo数据使用Spectrum模型来呈现国家层面的艾滋病毒数据。艾滋病毒病例超过4万例的国家被分为高流行率（≥4.5%）和低流行率（<4.5%）两类。采用最小二乘线性回归，以流行规模为权重并控制人均国内生产总值，比较成人（≥15岁）、儿童（0 - 14岁）、孕妇的艾滋病毒流行率与估计的抗逆转录病毒疗法覆盖率，以及早期婴儿诊断率和母婴传播率。然后比较高流行率组和低流行率组之间的数据，包括新增艾滋病毒感染人数和与艾滋病相关的死亡人数。
有56个国家的数据可供分析。12个高流行率国家有1670万艾滋病毒感染者，44个低流行率国家有1510万，总计占全球估计数的87.5%。低流行率国家的成人、孕妇和儿童接受抗逆转录病毒疗法的覆盖率较低，早期婴儿诊断率较低，与艾滋病相关的死亡水平较高。低流行率国家的成人和儿童中新增艾滋病毒感染病例比高流行率国家更多。
大多数新增艾滋病毒感染、母婴传播病例以及与艾滋病相关的死亡发生在艾滋病毒流行率低于4.5%的国家。这些国家中的许多并未被诸如总统艾滋病紧急救援计划等获取计划列为目标对象。为了到2020年将全球每年新增艾滋病毒感染人数降至50万以下，这些国家需要更密集的诊断和治疗计划。
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