Jewell Britta L, Smith Jennifer A, Hallett Timothy B
MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
EClinicalMedicine. 2020 Jul 31;26:100483. doi: 10.1016/j.eclinm.2020.100483. eCollection 2020 Sep.
There is concern that the COVID-19 pandemic could severely disrupt HIV services in sub-Saharan Africa. However, it is difficult to determine priorities for maintaining different elements of existing HIV services given widespread uncertainty.
We explore the impact of disruptions on HIV outcomes in South Africa, Malawi, Zimbabwe, and Uganda using a mathematical model, examine how impact is affected by model assumptions, and compare potential HIV deaths to those that may be caused by COVID-19 in the same settings.
The most important determinant of HIV-related mortality is an interruption to antiretroviral treatment (ART) supply. A three-month interruption for 40% of those on ART could cause a similar number of additional deaths as those that might be saved from COVID-19 through social distancing. An interruption for more than 6-90% of individuals on ART for nine months could cause the number of HIV deaths to exceed the number of COVID-19 deaths, depending on the COVID-19 projection. However, if ART supply is maintained, but new treatment, voluntary medical male circumcision, and pre-exposure prophylaxis initiations cease for 3 months and condom use is reduced, increases in HIV deaths would be limited to <2% over five years, although this could still be accompanied by a 7% increase in new HIV infections.
HIV deaths could increase substantially during the COVID-19 pandemic under reasonable worst-case assumptions about interruptions to HIV services. It is a priority in high-burden countries to ensure continuity of ART during the pandemic.
Bill & Melinda Gates Foundation.
人们担心新冠疫情可能会严重扰乱撒哈拉以南非洲地区的艾滋病服务。然而，鉴于广泛存在的不确定性，很难确定维持现有艾滋病服务不同要素的优先事项。
我们使用数学模型探究南非、马拉维、津巴布韦和乌干达艾滋病服务中断对艾滋病相关结果的影响，研究模型假设如何影响这种影响，并将潜在的艾滋病死亡人数与同一环境下可能由新冠病毒导致的死亡人数进行比较。
与艾滋病相关死亡率的最重要决定因素是抗逆转录病毒治疗（ART）供应中断。对于40%接受抗逆转录病毒治疗的患者来说，三个月的供应中断可能导致的额外死亡人数与通过社交距离措施可能从新冠疫情中挽救的死亡人数相近。对于超过6 - 90%接受抗逆转录病毒治疗的患者来说，九个月的供应中断可能导致艾滋病死亡人数超过新冠病毒导致的死亡人数，具体取决于对新冠疫情的预测。然而，如果维持抗逆转录病毒治疗的供应，但新治疗、自愿医学男性包皮环切术和暴露前预防的启动停止3个月，并且避孕套使用减少，艾滋病死亡人数在五年内的增加将限制在<2%，尽管这仍可能伴随着新感染艾滋病毒人数增加7%。
在对艾滋病服务中断的合理最坏情况假设下，新冠疫情期间艾滋病死亡人数可能大幅增加。在高负担国家，在疫情期间确保抗逆转录病毒治疗的连续性是当务之急。
比尔及梅琳达·盖茨基金会。
