Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
National Institute for Health Development, Tallinn, Estonia.
AIDS. 2021 Mar 15;35(4):675-680. doi: 10.1097/QAD.0000000000002778.
In the early 2000s, Estonia and Latvia experienced a rapidly growing HIV epidemic among people who inject drugs (PWID), and had, with Russia, the highest diagnosis rates in Europe. Understanding epidemic dynamics in both countries and how responses to HIV impacted them is essential to ending injection-driven epidemics.
Statistical modeling, programmatic data collection, and triangulation.
Data on newly diagnosed HIV cases were used in a back-calculation model to estimate, for each country, trends in HIV incidence, time to diagnosis, and undiagnosed infections. Modeled estimates were then triangulated with programmatic data on harm reduction services, HIV testing, and ART.
From 2007 to 2016, HIV incidence decreased in Estonia by 61% overall, for all exposure groups, and particularly for male PWID (97%), except men who have sex with men, where it increased by 418%. In Latvia, it increased by 72% overall. Median time to diagnosis decreased for male PWID in Estonia, from 3.5 to 2.6 years, but not in Latvia. In 2016, most new and undiagnosed infections, ∼50% in Latvia and ∼75% in Estonia, affected individuals reporting heterosexual transmission, showing a gradual shift toward heterosexual route as the main reported exposure mode. Coverage of services had been higher in Estonia; for example, by 2016, for PWID, there were >200 needles and syringes distributed per PWID annually, and HIV testing and ART coverage reached ∼50% and 76%, respectively, in Estonia, against respectively less than 100%, 10% and 27% in Latvia.
Estonia has turned the tide of its epidemic - large scale-up of prevention and care programs probably contributed to it - whereas in Latvia it remains very active.
21 世纪初，爱沙尼亚和拉脱维亚的吸毒人群（PWID）中艾滋病毒感染迅速蔓延，与俄罗斯一起成为欧洲艾滋病毒诊断率最高的国家。了解这两个国家的疫情动态以及对艾滋病毒的应对措施如何影响疫情至关重要，这有助于终结由注射吸毒导致的艾滋病流行。
统计建模、规划数据收集和三角剖分。
使用新诊断的艾滋病毒病例数据，通过回溯模型估算两国艾滋病毒发病率、诊断时间和未诊断感染的趋势。然后，将模型估算值与关于减少伤害服务、艾滋病毒检测和抗逆转录病毒治疗的规划数据进行三角剖分。
2007 年至 2016 年，爱沙尼亚艾滋病毒总体发病率下降了 61%，所有暴露组均呈下降趋势，特别是男性 PWID（97%），除男男性行为者外，其发病率上升了 418%。拉脱维亚的发病率则上升了 72%。爱沙尼亚男性 PWID 的诊断时间中位数从 3.5 年缩短至 2.6 年，但拉脱维亚没有变化。2016 年，大多数新发现和未诊断的感染病例（爱沙尼亚约为 50%，拉脱维亚约为 75%）影响到报告异性传播的个体，表明异性传播作为主要报告的暴露模式逐渐成为主流。爱沙尼亚的服务覆盖率较高；例如，到 2016 年，每年为 PWID 分发的针头和注射器超过 200 个，艾滋病毒检测和抗逆转录病毒治疗的覆盖率分别达到约 50%和 76%，而拉脱维亚的相应覆盖率分别不到 100%、10%和 27%。
爱沙尼亚已扭转疫情局面——大规模扩大预防和护理方案可能对此起到了推动作用——而拉脱维亚的疫情仍然十分活跃。
