198006United Nations Development Programme, Kabul, Afghanistan.
Ministry of Public Health, Kabul, Afghanistan.
Int J STD AIDS. 2022 Mar;33(3):282-288. doi: 10.1177/09564624211055299. Epub 2021 Dec 15.
Afghanistan adopted a "test and treat" strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018.
We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression.
Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35-44 years old (52.0%, -value .001), acquired HIV through unsafe injection (62.5%, -value .413), were co-infected with hepatitis C virus (HCV) (60.0%, -value .449), and with CD4 > 500 at diagnosis (64.7%, -value .294) were less likely to be virally suppressed 12 months after diagnosis.
Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.
阿富汗于 2016 年为所有艾滋病毒感染者（PLWH）采用了“检测和治疗”策略。在这项研究中，我们介绍了 2013 年至 2019 年间诊断出的所有患者的人口统计学和临床特征，并评估了在阿富汗 2018 年诊断出的 PLWH 中实现联合国艾滋病规划署 90-90-90 目标的进展情况，并确定了项目差距。
我们使用了国家艾滋病毒监测的临床、行为和人口统计学数据，这些数据来自于 2013 年至 2019 年期间诊断出的 1394 名患者。我们还对 2018 年诊断出的 184 名艾滋病毒感染者进行了 15 个月的跟踪，以评估他们接受护理、开始接受抗逆转录病毒治疗（ART）、维持 ART 治疗以及病毒抑制情况。
在 2013 年至 2019 年期间诊断出的 1394 名患者中，76.0%为男性，73.7%年龄大于 24 岁，33.4%通过异性性接触感染艾滋病毒。在 2018 年诊断出的 184 名患者中，94.6%接受了护理，88.6%接受了抗逆转录病毒治疗，84.2%至少维持了 12 个月的抗逆转录病毒治疗，33.7%接受了病毒载量检测。在接受病毒载量检测的患者中，74.2%病毒得到抑制。35-44 岁的患者（52.0%，-值.001）、通过不安全注射感染 HIV 的患者（62.5%，-值.413）、同时感染丙型肝炎病毒（HCV）的患者（60.0%，-值.449）以及诊断时 CD4 计数>500 的患者（64.7%，-值.294）在诊断后 12 个月病毒抑制的可能性较低。
2018 年在阿富汗诊断出的艾滋病毒感染者中，近 95%已与护理服务建立联系，近 90%正在接受抗逆转录病毒治疗。艾滋病毒检测和病毒抑制率仍然较低，中年患者和可能注射毒品的患者之间存在明显差异。迫切需要解决阿富汗艾滋病毒项目的障碍，特别是针对注射吸毒者（PWID）的障碍，以实现全球 90-90-90 目标。需要有关于未确诊艾滋病毒感染者人数的监测数据，以评估第一个 90 目标。
