Institute for Global Health Sciences, University of California (UCSF), San Francisco, USA.
Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.
BMC Public Health. 2021 Jan 15;21(1):146. doi: 10.1186/s12889-020-10039-2.
Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises in Mozambique estimate that key populations (KP), defined as men who have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID), along with their partners account for about one third of all new infections. There is limited data describing the engagement of KP living with HIV in testing, care and treatment services.
We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique conducted 2011-2014 in order to assess service uptake and progress though the HIV treatment cascade among MSM, FSW, and PWID. Unweighted pooled estimates were calculated for each key population group.
Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey.
Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade in line with global targets and should include viral load testing to guarantee a more complete picture of the treatment cascade.
莫桑比克普通人群中 HIV 感染率普遍为 13.5%。莫桑比克早期的建模研究估计，重点人群（KP），包括男男性行为者（MSM）、性工作者（FSW）和注射毒品者（PWID）及其性伴侣，约占所有新感染人数的三分之一。目前关于 HIV 阳性重点人群接受检测、护理和治疗服务的情况数据有限。
我们对 2011-2014 年期间在莫桑比克进行的首次生物行为监测（BBS）调查中 HIV 阳性参与者进行了二次数据分析，以评估 MSM、FSW 和 PWID 通过 HIV 治疗阶梯的服务利用情况和进展情况。对每个重点人群组计算了未加权的汇总估计数。
在 HIV 阳性的男男性行为者中，63.2%的参与者曾接受过 HIV 检测，8.8%的人知晓自己的 HIV 状况，6.1%的人报告已被转介到护理机构，而 3.5%的人开始接受抗逆转录病毒治疗并正在接受治疗。在 HIV 感染的性工作者中，76.5%的人报告曾接受过 HIV 检测，22.4%的人以前知晓自己的 HIV 状况。报告已被转介到护理机构的人占 20.1%，12.7%的人报告已开始接受抗逆转录病毒治疗，11.8%的人报告在调查时正在接受治疗。在 HIV 感染的注射吸毒者中，79.9%的人以前接受过 HIV 检测，63.2%的人知晓自己的 HIV 状况，49.0%的人报告其 HIV 感染已被转介到护理机构。报告开始接受抗逆转录病毒治疗的人占 42.7%，29.4%的人在调查时正在接受抗逆转录病毒治疗。
在莫桑比克的三个高危人群中，在服务利用的关键领域都出现了损失，最令人担忧的是在知晓 HIV 状况方面出现了断点。应特别关注增加 HIV 检测和转介到抗逆转录病毒治疗。未来的调查将提供机会，根据全球目标监测整个治疗阶梯的改善情况，并且应该包括病毒载量检测，以更全面地了解治疗阶梯。
