Bixby Center for Global Reproductive Health, Department of Obstetrics,Gynecology & Reproductive Sciences, University of California, San Francisco, ANSIRH Program, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA.
Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th Street, 3rd Floor, UCSF Mail Code 0886, San Francisco, CA, 94158, USA.
Curr HIV/AIDS Rep. 2019 Aug;16(4):314-323. doi: 10.1007/s11904-019-00457-2.
We reviewed literature across multiple disciplines to describe issues with the measurement of population mobility in HIV research and to summarize evidence of causal pathways linking mobility to HIV acquisition risks and treatment engagement, with a focus on sub-Saharan Africa.
While the literature on mobility and HIV remains hampered by problems and inconsistency in measures of mobility, the recent research reveals a turn towards a greater attentiveness to measurement and gender. Theoretical and heuristic models for the study of mobility and HIV acquisition and treatment outcomes have been published, but few studies have used longitudinal designs with clear ascertainment of exposures and outcomes for measurement of causal pathways. Notwithstanding these limitations, evidence continues to accumulate that mobility is linked to higher HIV incidence, and that it challenges optimal treatment engagement. Gender continues to be important: while men are more mobile than women, women's mobility particularly heightens their HIV acquisition risks. Recent large-scale efforts to find, test, and treat the individuals in communities who are most at risk of sustaining local HIV transmission have been severely challenged by mobility. Novel interventions, policies, and health systems improvements are urgently needed to fully engage mobile individuals in HIV care and prevention. Interventions targeting the HIV prevention and care needs of mobile populations remain few in number and urgently needed.
目的综述：我们查阅了多个学科的文献，描述了在 HIV 研究中衡量人群流动性时存在的问题，并总结了流动性与 HIV 感染风险和治疗参与之间因果关系的证据，重点关注撒哈拉以南非洲地区。
最新发现：尽管关于流动性和 HIV 的文献仍然受到流动性衡量方法的问题和不一致性的阻碍，但最近的研究表明，人们越来越关注衡量方法和性别问题。已经发表了用于研究流动性和 HIV 感染及治疗结果的理论和启发式模型，但很少有研究使用纵向设计，明确确定暴露和结果来衡量因果关系。尽管存在这些局限性，但越来越多的证据表明，流动性与更高的 HIV 发病率有关，并且会对最佳治疗参与产生挑战。性别仍然很重要：虽然男性比女性更具流动性，但女性的流动性特别会增加她们感染 HIV 的风险。最近为在社区中找到、检测和治疗最有可能持续传播 HIV 的高危个体而进行的大规模努力，因流动性而受到严重挑战。迫切需要新的干预措施、政策和卫生系统改进，以使流动个体充分参与 HIV 护理和预防。针对流动人群的 HIV 预防和护理需求的干预措施数量仍然很少，非常需要。
