Epicentre, Paris, France.
Médecins Sans Frontières (MSF), Harare, Zimbabwe.
J Int AIDS Soc. 2020 Sep;23(9):e25613. doi: 10.1002/jia2.25613.
Gutu, a rural district in Zimbabwe, has been implementing comprehensive HIV care with the support of Médecins Sans Frontières (MSF) since 2011, decentralizing testing and treatment services to all rural healthcare facilities. We evaluated HIV prevalence, incidence and the cascade of care, in Gutu District five years after MSF began its activities.
A cross-sectional study was implemented between September and December 2016. Using multistage cluster sampling, individuals aged ≥15 years living in the selected households were eligible. Individuals who agreed to participate were interviewed and tested for HIV at home. All participants who tested HIV-positive had their HIV-RNA viral load (VL) measured, regardless of their antiretroviral therapy (ART) status, and those not on ART with HIV-RNA VL ≥ 1000 copies/mL had Limiting-Antigen-Avidity EIA Assay for cross-sectional estimation of population-level HIV incidence.
Among 5439 eligible adults ≥15 years old, 89.0% of adults were included in the study and accepted an HIV test. The overall prevalence was 13.6% (95%: Confidence Interval (CI): 12.6 to 14.5). Overall HIV-positive status awareness was 87.4% (95% CI: 84.7 to 89.8), linkage to care 85.5% (95% CI: 82.5 to 88.0) and participants in care 83.8% (95% CI: 80.7 to 86.4). ART coverage among HIV-positive participants was 83.0% (95% CI: 80.0 to 85.7). Overall, 71.6% (95% CI 68.0 to 75.0) of HIV-infected participants had a HIV-RNA VL < 1000 copies/mL. Women achieved higher outcomes than men in the five stages of the cascade of care. Viral Load Suppression (VLS) among participants on ART was 83.2% (95% CI: 79.7 to 86.2) and was not statistically different between women and men (p = 0.98). The overall HIV incidence was estimated at 0.35% (95% CI 0.00 to 0.70) equivalent to 35 new cases/10,000 person-years.
Our study provides population-level evidence that achievement of HIV cascade of care coverage overall and among women is feasible in a context with broad access to services and implementation of a decentralized model of care. However, the VLS was relatively low even among participants on ART. Quality care remains the most critical gap in the cascade of care to further reduce mortality and HIV transmission.
津巴布韦古图地区自 2011 年以来在无国界医生组织的支持下一直实施综合艾滋病毒护理，将检测和治疗服务下放到所有农村医疗设施。我们评估了古图地区在无国界医生组织开始活动五年后艾滋病毒的流行率、发病率和护理级联。
2016 年 9 月至 12 月期间实施了一项横断面研究。采用多阶段聚类抽样，选择居住在选定家庭中的年龄≥15 岁的个人。同意参加的个人在家中接受艾滋病毒检测和访谈。所有艾滋病毒检测呈阳性的参与者均进行 HIV-RNA 病毒载量（VL）测量，无论其是否接受抗逆转录病毒治疗（ART），且未接受 ART 且 HIV-RNA VL≥1000 拷贝/ml 的参与者采用 Limiting-Antigen-Avidity EIA 测定法进行人群水平 HIV 发病率的横断面估计。
在 5439 名符合条件的≥15 岁成年人中，89.0%的成年人被纳入研究并接受了艾滋病毒检测。总流行率为 13.6%（95%置信区间：12.6 至 14.5）。总的艾滋病毒阳性状态知晓率为 87.4%（95%置信区间：84.7 至 89.8），与护理的联系率为 85.5%（95%置信区间：82.5 至 88.0），接受护理的参与者为 83.8%（95%置信区间：80.7 至 86.4）。HIV 阳性参与者的 ART 覆盖率为 83.0%（95%置信区间：80.0 至 85.7）。总体而言，71.6%（95%置信区间 68.0 至 75.0）的 HIV 感染者的 HIV-RNA VL<1000 拷贝/ml。女性在护理级联的五个阶段中的结果均优于男性。接受 ART 治疗的参与者中病毒载量抑制（VLS）为 83.2%（95%置信区间：79.7 至 86.2），女性和男性之间的 VLS 没有统计学差异（p=0.98）。总体 HIV 发病率估计为 0.35%（95%置信区间 0.00 至 0.70），相当于每 10000 人年有 35 例新发病例。
我们的研究提供了人群水平的证据，表明在广泛获得服务和实施分散护理模式的情况下，整体和女性的艾滋病毒护理级联的覆盖范围是可行的。然而，即使在接受 ART 的参与者中，VL 也相对较低。优质护理仍然是护理级联中最关键的差距，需要进一步降低死亡率和艾滋病毒传播。
