Mesurado Cooperative, Cambridge, MA, USA.
Clinton Health Access Initiative (CHAI), 333 Dorchester Avenue, Boston, MA, USA.
Curr HIV/AIDS Rep. 2020 Aug;17(4):324-332. doi: 10.1007/s11904-020-00501-6.
The MaxART Consortium-led by the Eswatini Ministry of Health-implemented multiple interventions between 2012 and 2017 to achieve UNAIDS 90-90-90 targets. We summarize key findings from community outreach strategies in support of the first 90 goal, and from the Early Access to ART for All (EAAA) trial on the implementation of a "Treat All" strategy to achieve the second and third 90 goals within a government-managed public health system.
The MaxART Consortium demonstrated that "Fast Track," a problem-solving approach, was effective at increasing testing coverage in the community. Compared with baseline data at 3 months prior to the start of the Fast Track, there was a 273% proportional increase in HIV tests conducted among adolescent males, adolescent females, and adult men, and 722% over baseline for adolescent males. The MaxART EAAA trial further showed that implementation of the Treat All policy was associated with significant two-fold shorter time from enrollment into care to ART initiation than under the standard CD4+ cell threshold-based treatment guidelines. Finally, through the MaxART trial, Eswatini was able to identify areas for further investment, including addressing the system-side barriers to routine viral load monitoring, and designing and implementing innovative community-based approaches to reach individuals who were not more routinely accessing HIV testing and counseling services. As low- and middle-income countries adopt the Treat All approach in their national HIV care and treatment guidelines, further implementation science research is needed to understand and address the system-level barriers to achieving the benefits of Treat All for HIV-infected individuals and those at risk.
综述目的：由斯威士卫生部门领导的 MaxART 联盟在 2012 年至 2017 年期间实施了多项干预措施，以实现艾滋病规划署的 90-90-90 目标。我们总结了支持实现第一个 90 目标的社区外展战略的关键发现，以及通过全民早期获取抗逆转录病毒治疗（EAAA）试验实施“治疗所有”策略以实现第二个和第三个 90 目标的关键发现，该策略在政府管理的公共卫生系统中实施。
最新发现：MaxART 联盟表明，“快速通道”，一种解决问题的方法，在提高社区检测覆盖率方面是有效的。与开始快速通道前 3 个月的基线数据相比，青少年男性、青少年女性和成年男性的 HIV 检测比例增加了 273%，而青少年男性的检测比例增加了 722%。MaxART EAAA 试验进一步表明，实施“治疗所有”政策与从登记护理到开始抗逆转录病毒治疗的时间相比，比基于 CD4+细胞阈值的标准治疗指南显著缩短了两倍。最后，通过 MaxART 试验，斯威士兰能够确定进一步投资的领域，包括解决常规病毒载量监测的系统障碍，以及设计和实施创新的社区方法，以覆盖那些没有更常规地接受艾滋病毒检测和咨询服务的人。随着中低收入国家在其国家艾滋病毒护理和治疗指南中采用“治疗所有”方法，需要进一步开展实施科学研究，以了解和解决实现“治疗所有”为艾滋病毒感染者和处于风险中的人带来益处的系统障碍。
