Department of Epidemiology, School of Public Health, Brown University, Providence, RI.
Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada.
J Acquir Immune Defic Syndr. 2022 Feb 1;89(2):143-150. doi: 10.1097/QAI.0000000000002844.
Understanding the sources of HIV transmission provides a basis for prioritizing HIV prevention resources in specific geographic regions and populations. This study estimated the number, proportion, and rate of HIV transmissions attributable to individuals along the HIV care continuum within different HIV transmission risk groups in 6 US cities.
We used a dynamic, compartmental HIV transmission model that draws on racial behavior-specific or ethnic behavior-specific and risk behavior-specific linkage to HIV care and use of HIV prevention services from local, state, and national surveillance sources. We estimated the rate and number of HIV transmissions attributable to individuals in the stage of acute undiagnosed HIV, nonacute undiagnosed HIV, HIV diagnosed but antiretroviral therapy (ART) naïve, off ART, and on ART, stratified by HIV transmission group for the 2019 calendar year.
Individuals with undiagnosed nonacute HIV infection accounted for the highest proportion of total transmissions in every city, ranging from 36.8% (26.7%-44.9%) in New York City to 64.9% (47.0%-71.6%) in Baltimore. Individuals who had discontinued ART contributed to the second highest percentage of total infections in 4 of 6 cities. Individuals with acute HIV had the highest transmission rate per 100 person-years, ranging from 76.4 (58.9-135.9) in Miami to 160.2 (85.7-302.8) in Baltimore.
These findings underline the importance of both early diagnosis and improved ART retention for ending the HIV epidemic in the United States. Differences in the sources of transmission across cities indicate that localized priority setting to effectively address diverse microepidemics at different stages of epidemic control is necessary.
了解 HIV 传播的源头为在特定地理区域和人群中优先分配 HIV 预防资源提供了依据。本研究估计了在美国 6 个城市的不同 HIV 传播风险组中，沿着 HIV 护理连续体的个体在 HIV 传播风险组内导致的 HIV 传播数量、比例和速率。
我们使用了一种动态的、分类的 HIV 传播模型，该模型利用种族行为特异性或族裔行为特异性以及与当地、州和国家监测来源的 HIV 护理和 HIV 预防服务的使用相关的风险行为特异性链接来绘制 HIV 传播。我们根据 HIV 传播组，估计了在急性未确诊 HIV、非急性未确诊 HIV、诊断为 HIV 但未接受抗逆转录病毒治疗（ART）、停止 ART 和接受 ART 治疗的个体中，归因于个体的 HIV 传播率和数量，分析时间为 2019 年。
在每个城市，未确诊的非急性 HIV 感染个体占总传播的比例最高，从纽约市的 36.8%（26.7%-44.9%）到巴尔的摩的 64.9%（47.0%-71.6%）。在 6 个城市中的 4 个城市中，停止 ART 的个体导致了第二高比例的总感染。急性 HIV 个体的每 100 人年的传播率最高，从迈阿密的 76.4（58.9-135.9）到巴尔的摩的 160.2（85.7-302.8）。
这些发现强调了早期诊断和提高 ART 保留率对在美国终结 HIV 流行的重要性。不同城市之间传播源的差异表明，需要针对不同阶段的流行控制采取本地化的优先设置，以有效解决不同的微观流行。
