整合和解读最新治疗即预防试验的结果。
Integrating and Interpreting Findings from the Latest Treatment as Prevention Trials.
机构信息
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
Department of Biostatistics; Center for Methods in Implementation and Prevention Sciences, Yale School of Public Health, New Haven, CT, USA.
出版信息
Curr HIV/AIDS Rep. 2020 Jun;17(3):249-258. doi: 10.1007/s11904-020-00492-4.
PURPOSE OF REVIEW
In 2018-2019, studies were published assessing the effectiveness of reducing HIV incidence by expanding HIV testing, linkage to HIV treatment, and assistance to persons living with HIV to adhere to their medications (the "90-90-90" strategy). These tests of "treatment as prevention" (TasP) had complex results.
RECENT FINDINGS
The TasP/ANRS 12249 study in South Africa, the SEARCH study in Kenya and Uganda, and one comparison (arms A to C) of the HPTN 071 (PopART) study in South Africa and Zambia did not demonstrate a community impact on HIV incidence. In contrast, the Botswana Ya Tsie study and the second comparison (arms B to C) of PopART indicated significant ≈ 30% reductions in HIV incidence in the intervention communities where TasP was expanded. We discuss the results of these trials and outline future research and challenges. These include the efficient expansion of widespread HIV testing, better linkage to care, and viral suppression among all persons living with HIV. A top implementation science priority for the next decade is to determine what strategies to use in specific local contexts.
目的综述
在 2018-2019 年，有研究发表评估了通过扩大 HIV 检测、将 HIV 感染者与 HIV 治疗相联系以及帮助 HIV 感染者坚持药物治疗（“90-90-90”策略）来降低 HIV 发病率的效果。这些“治疗即预防”（TasP）的测试结果复杂。
最近的发现
南非的 TasP/ANRS 12249 研究、肯尼亚和乌干达的 SEARCH 研究以及南非和赞比亚的 HPTN 071（PopART）研究的一个比较（臂 A 至 C）并未表明对社区 HIV 发病率有影响。相比之下，博茨瓦纳 Ya Tsie 研究和 PopART 的第二个比较（臂 B 至 C）表明，在扩大 TasP 的干预社区中，HIV 发病率显著降低了约 30%。我们讨论了这些试验的结果，并概述了未来的研究和挑战。这些挑战包括高效扩大广泛的 HIV 检测、更好地将感染者与治疗相联系以及提高所有 HIV 感染者的病毒抑制率。下一个十年的一个顶级实施科学重点是确定在特定的当地环境中使用哪些策略。
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