Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
Department of Biostatistics and Bioinformatics, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America.
PLoS One. 2021 Apr 19;16(4):e0250179. doi: 10.1371/journal.pone.0250179. eCollection 2021.
The U.S. Ending the HIV Epidemic (EHE) initiative was announced in early 2019 and rapidly became a focal point for domestic HIV prevention and treatment programs. Using publicly available data from CDC, we examined historical trends in the average annual percent change (AAPC) in HIV diagnosis rates for the 57 EHE high incidence "hotspots" using Joinpoint analysis. We then assessed the ecologic association of various hotspot characteristics with changes in these rates over time using a multivariable regression model. From 2008-2017, the overall rate of newly diagnosed HIV cases in the U.S. declined from 19 to 14 per 100,000 persons, with the AAPC declining significantly in the U.S. overall (-3.1%; 95% CI: -3.7, -2.4) and in the 57 hotspots (-3.3%; 95% CI: -4.6, -2.8). There were large (AAPC <-5.0), moderate (-5.0 to -2.5) and small (-2.5 to 0.0) rates of decline in 14, 19 and 17 hotspots respectively, with increasing trends (AAPC >0.0) noted in seven hotspots. In the multivariable regression analysis, higher initial HIV diagnosis rate and location in the Northeast region were significantly associated with declining AAPC rates whereas no significant differences were found by hotspot gender, age, or race/ethnicity distribution. This analysis demonstrates that the rate of decline in HIV diagnosis rates in hotspots across the U.S. has been highly variable. Further exploration is warranted to assess the correlation between programmatic factors such as HIV testing and antiretroviral therapy and pre-exposure prophylaxis coverage with HIV trends across the hotspots.
美国终结艾滋病疫情（EHE）倡议于 2019 年初宣布，并迅速成为国内艾滋病预防和治疗项目的重点。我们利用疾病预防控制中心（CDC）公开提供的数据，使用 Joinpoint 分析，检查了 57 个 EHE 高发病率“热点”地区艾滋病毒诊断率的年平均百分比变化（AAPC）的历史趋势。然后，我们使用多变量回归模型评估了各种热点特征与这些比率随时间变化的生态关联。从 2008 年到 2017 年，美国新诊断的艾滋病毒病例率从每 10 万人 19 例降至 14 例，美国总体（-3.1%；95%CI：-3.7，-2.4）和 57 个热点地区（-3.3%；95%CI：-4.6，-2.8）的 AAPC 显著下降。在 14 个、19 个和 17 个热点地区，分别有较大（AAPC<-5.0）、中等（-5.0 至-2.5）和较小（-2.5 至 0.0）的下降率，7 个热点地区的趋势呈上升趋势（AAPC>0.0）。在多变量回归分析中，较高的初始艾滋病毒诊断率和东北部地区的位置与 AAPC 率下降显著相关，而热点地区的性别、年龄或种族/族裔分布无显著差异。这项分析表明，美国各地热点地区艾滋病毒诊断率下降的速度差异很大。需要进一步探讨，以评估艾滋病毒检测和抗逆转录病毒治疗以及暴露前预防覆盖率等项目因素与热点地区艾滋病毒趋势之间的相关性。
