Médecins sans Frontières, Barcelona, Spain.
Épicentre, Dakar, Senegal.
PLoS One. 2021 Jul 12;16(7):e0254331. doi: 10.1371/journal.pone.0254331. eCollection 2021.
Antiretroviral therapy (ART) coverage in South Sudan is around 10%. Access to HIV care in settings with low ART coverage or conflict affected is still low; innovative strategies are needed to increase access and ensure continuation of ART during instability. A pilot HIV test and start project was implemented in a conflict-affected area of South Sudan. In a retrospective analysis, we determined the feasibility and outcomes of this intervention.
Programme data from July 2015 to June 2018 was analysed. The project involved five mobile teams offering HIV counselling and testing (HCT) and same day ART initiation at community level. Baseline and follow-up information on clinical, immunological and viral load (VL) was routinely recorded, as well as treatment outcomes. A semi-qualitative study was conducted to assess acceptability of the program among beneficiaries and community members.
By June 2018, 14824 people received counselling and testing for HIV and 498 (3.4%) tested positive. Out of those 395 (79.3%) started ART. A total of 72 ART patients were organized in 26 Community ART Groups (CAGs) and contingency plan was activated 9 times for 101 patients. Kaplan-Meier estimated retention in care (RIC) at 12 and 18 months was 80.6% [95% CI: 75.9-84.5%] and 69.9% [95% CI: 64.4-74.8%] respectively. RIC was significantly higher at 18 months in patients under community ART groups (CAGs) (90.9% versus 63.4% p<0.001) when compared to patients on regular follow up. VL suppression at 12 months was 90.3% and overall virological suppression reached 91.2%. A total of 279 persons were interviewed about the MSF program perception and acceptance: 98% had heard about the programme and 84% found it beneficial for the community, 98% accepted to be tested and only 4% found disadvantages to the programme.
Our study shows that HCT and early ART initiation in conflict affected populations can be provided with good program outcomes. RIC and virological suppression are comparable with facility-based HIV programs and to those in stable contexts. This model could be extrapolated to other similar contexts with low access to ART and where security situation is a concern.
南苏丹的抗逆转录病毒疗法（ART）覆盖率约为 10%。在 ART 覆盖率低或受冲突影响的地方获得艾滋病毒护理的机会仍然很低；需要创新战略来增加获得机会，并确保在不稳定期间继续进行 ART。在南苏丹受冲突影响的地区实施了一项 HIV 检测和启动试点项目。在回顾性分析中，我们确定了该干预措施的可行性和结果。
分析了 2015 年 7 月至 2018 年 6 月的数据。该项目涉及五个流动小组，在社区一级提供艾滋病毒咨询和检测（HCT）以及当天开始的 ART。常规记录了临床、免疫和病毒载量（VL）的基线和随访信息，以及治疗结果。进行了一项半定性研究，以评估该方案在受益人和社区成员中的可接受性。
截至 2018 年 6 月，共有 14824 人接受了 HIV 咨询和检测，498 人（3.4%）检测呈阳性。其中 395 人（79.3%）开始接受 ART。共有 72 名 ART 患者被组织到 26 个社区 ART 小组（CAG）中，并为 101 名患者启动了 9 次应急计划。12 个月和 18 个月的 Kaplan-Meier 估计护理保留率（RIC）分别为 80.6%[95%CI：75.9-84.5%]和 69.9%[95%CI：64.4-74.8%]。与定期随访的患者相比，在社区 ART 小组（CAG）下的患者在 18 个月时 RIC 显著更高（90.9%比 63.4%，p<0.001）。12 个月时的 VL 抑制率为 90.3%，总体病毒学抑制率达到 91.2%。共有 279 人接受了有关无国界医生组织项目看法和接受程度的访谈：98%听说过该方案，84%认为该方案对社区有益，98%接受检测，只有 4%认为该方案有弊端。
我们的研究表明，在受冲突影响的人群中提供 HIV 检测和早期 ART 启动可以获得良好的项目结果。RIC 和病毒学抑制与基于设施的 HIV 方案相当，也与稳定环境中的情况相当。这种模式可以推广到其他类似的 ART 获得机会低且安全局势令人担忧的环境中。
