Nkambule Rejoice, Philip Neena M, Reid Giles, Mnisi Zandile, Nuwagaba-Biribonwoha Harriet, Ao Tony T, Ginindza Choice, Duong Yen T, Patel Hetal, Saito Suzue, Solmo Chelsea, Brown Kristin, Moore Chiara S, Voetsch Andrew C, Bicego George, Bock Naomi, Mhlanga Fortune, Dlamini Tengetile, Mabuza Khanya, Zwane Amos, Sahabo Ruben, Dobbs Trudy, Parekh Bharat S, El-Sadr Wafaa, Ryan Caroline, Justman Jessica
Ministry of Health, Mbabane, Eswatini.
ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America.
PLoS One. 2021 Dec 2;16(12):e0260892. doi: 10.1371/journal.pone.0260892. eCollection 2021.
With the highest HIV incidence and prevalence globally, the government of Eswatini started a substantial scale-up of HIV treatment and prevention services in 2011. Two sequential large population-based surveys were conducted before and after service expansion to assess the impact of the national response. Cross-sectional, household-based, nationally representative samples of adults, ages 18 to 49 years, were sampled in 2011 and 2016. We measured HIV prevalence, incidence (recent infection based on limiting antigen ≤1.5 optical density units and HIV RNA ≥1000 copies/mL), viral load suppression (HIV RNA <1000 copies/mL among all seropositive adults) and unsuppressed viremia (HIV RNA ≥1000 copies/mL among all, regardless of HIV status) and assessed for temporal changes by conducting a trend analysis of the log ratio of proportions, using a Z statistic distribution. HIV prevalence remained stable from 2011 to 2016 [32% versus 30%, p = 0.10]. HIV incidence significantly declined 48% [2.48% versus 1.30%, p = 0.01]. Incidence remained higher among women than men [2011: 3.16% versus 1.83%; 2016: 1.76% versus 0.86%], with a smaller but significant relative reduction among women [44%; p = 0.04] than men [53%; p = 0.09]. The proportion of seropositive adults with viral load suppression significantly increased from 35% to 71% [p < .001]. The proportion of the total adult population with unsuppressed viremia decreased from 21% to 9% [p < .001]. National HIV incidence in Eswatini decreased by nearly half and viral load suppression doubled over a five-year period. Unsuppressed viremia in the total population decreased 58%. These population-based findings demonstrate the national impact of expanded HIV services in a hyperendemic country.
斯威士兰是全球艾滋病毒发病率和流行率最高的国家之一，该国政府于2011年开始大规模扩大艾滋病毒治疗和预防服务。在服务扩大前后进行了两次连续的大规模基于人群的调查，以评估国家应对措施的影响。2011年和2016年对18至49岁的成年人进行了横断面、基于家庭的全国代表性抽样。我们测量了艾滋病毒流行率、发病率（基于限制性抗原≤1.5光密度单位和艾滋病毒RNA≥1000拷贝/毫升的近期感染）、病毒载量抑制（所有血清阳性成年人中艾滋病毒RNA<1000拷贝/毫升）和病毒血症未抑制（所有人群中艾滋病毒RNA≥1000拷贝/毫升，无论艾滋病毒状态如何），并通过使用Z统计分布对比例的对数比进行趋势分析来评估时间变化。2011年至2016年艾滋病毒流行率保持稳定[32%对30%，p = 0.10]。艾滋病毒发病率显著下降48%[2.48%对1.30%，p = 0.01]。女性发病率仍高于男性[2011年：3.16%对1.83%；2016年：1.76%对0.86%]，女性相对下降幅度较小但显著[44%；p = 0.04]，低于男性[53%；p = 0.09]。病毒载量得到抑制的血清阳性成年人比例从35%显著增加到71%[p <.001]。病毒血症未抑制的成年总人口比例从21%下降到9%[p <.001]。在五年时间里，斯威士兰的全国艾滋病毒发病率下降了近一半，病毒载量抑制率翻了一番。总人口中病毒血症未抑制率下降了58%。这些基于人群的研究结果证明了在一个高流行国家扩大艾滋病毒服务的国家影响。
