Department of Communicable Diseases Prevention and Control, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt.
Department of Communicable Diseases Prevention and Control, World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt.
Lancet HIV. 2022 Feb;9(2):e112-e119. doi: 10.1016/S2352-3018(21)00320-9.
Worldwide, HIV incidence, and mortality has decreased since 2010; however, in the WHO Eastern Mediterranean region, trends continue to increase. We reviewed the regional progress to understand determinants of this situation and inform strategies to accelerate the response.
We conducted a multicountry programme review of 22 countries in the WHO Eastern Mediterranean region from Jan 1, 2010 to Dec 31, 2020. We extracted data from WHO's global AIDS monitoring system, UNAIDS estimates, and country reports regarding incident cases, policy uptake, and antiretrovirals used. We analysed data to describe incidence, testing practices, treatment coverage, and mortality to identify bottlenecks leading to persisting incidence and mortality.
Due to COVID-19 disruptions, the volume of HIV testing in 2020 halved to 3·0 million tests compared with 2019 with 8017 people living with HIV identified (0·27% positivity yield). In comparison with a 0·18% positivity yield from the 6·5 million tests in 2019. HIV tests were done in migrants (59·6%), groups at low risk (38·9%), and key populations (1·5%). Diagnoses with advanced disease increased from 27·3% in 2017 to 37·0% in 2019. In 2019, among 52 318 people on treatment, only 2888 (6%) received optimised regimens as per WHO recommendations. The number of people on treatment increased from 19 000 in 2010 with a coverage of 8% to 110 000 in 2020 with a coverage of 25%. Late diagnoses and suboptimal regimens could explain the increase in mortality from 9600 in 2010 to 17 000 in 2020.
In the Eastern Mediterranean region, inefficient testing and suboptimal treatment lead to underdiagnosis, persisting transmission, late treatment, and rising mortality. The HIV epidemic is growing faster than the response. A change in thinking is needed to test groups at high risk, transition to optimised treatment, and deliver patient-centred services that maximise retention.
World Health Organization.
自 2010 年以来，全球艾滋病毒发病率和死亡率有所下降；然而，在世界卫生组织东地中海区域，这一趋势仍在继续上升。我们审查了该区域的进展情况，以了解造成这种情况的决定因素，并为加快应对提供信息。
我们对 2010 年 1 月 1 日至 2020 年 12 月 31 日期间世界卫生组织东地中海区域的 22 个国家进行了多国方案审查。我们从世卫组织全球艾滋病监测系统、艾滋病规划署估计数以及国家报告中提取了关于新发病例、政策采纳和使用的抗逆转录病毒药物的数据。我们对数据进行了分析，以描述发病率、检测做法、治疗覆盖率和死亡率，以确定导致发病率和死亡率持续存在的瓶颈。
由于 COVID-19 疫情的干扰，2020 年艾滋病毒检测量减半，仅为 300 万次，而当年发现的艾滋病毒感染者为 8017 人（阳性检出率为 0.27%）。与 2019 年 650 万次检测中 0.18%的阳性检出率相比，检测量有所下降。艾滋病毒检测在移民（59.6%）、低风险人群（38.9%）和重点人群（1.5%）中进行。晚期诊断的病例从 2017 年的 27.3%增加到 2019 年的 37.0%。2019 年，在 52318 名接受治疗的患者中，只有 2888 人（6%）按照世卫组织的建议接受了最佳治疗方案。接受治疗的人数从 2010 年的 19000 人增加到 2020 年的 110000 人，覆盖率从 8%增加到 25%。由于诊断延迟和治疗方案欠佳，2010 年至 2020 年期间，死亡率从 9600 人上升至 17000 人。
在东地中海区域，低效检测和治疗方案欠佳导致诊断不足、持续传播、治疗延迟和死亡率上升。艾滋病毒流行的速度超过了应对的速度。需要改变思维方式，对高危人群进行检测，过渡到最佳治疗方案，并提供以患者为中心的服务，以最大限度地提高保留率。
世界卫生组织。
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