Epicentre, Paris, France.
Médecins sans Frontières, Eshowe, South Africa.
PLoS One. 2022 Mar 24;17(3):e0265488. doi: 10.1371/journal.pone.0265488. eCollection 2022.
High coverage of antiretroviral therapy (ART) in people living with HIV (PLHIV) increases viral suppression at population level and may reduce incidence. Médecins sans Frontières, in collaboration with the South African Department of Health, has been working in Eshowe/Mbongolwane (KwaZulu Natal) since 2011 to increase access to quality HIV services. Five years after an initial survey, we conducted a second survey to measure progress in HIV diagnosis and viral suppression and to identify remaining gaps.
A cross-sectional, population-based, stratified two-stage cluster survey was implemented in 2018, using the same design as in 2013. Consenting participants aged 15-59 years were interviewed and tested for HIV at home. Those HIV-positive were tested for HIV viral load (viral suppression defined as <1000 copies/mL).
Overall, 3,278 individuals were included. The proportion of HIV-positive participants virally suppressed was 83.8% in 2018 compared to 57.1% in 2013 (p<0.001), with increases in all subpopulations. The largest gap remained in men aged 15-29 years, among whom viral suppression was 51.5%. Nevertheless, of the total unsuppressed participants, 60.3% were women, and 57.4% were individuals aged 30-59 years. Between 2013 and 2018, HIV-positive status awareness progressed from 75.2% to 89.9% and ART coverage among those aware from 70.4% to 93.8%, respectively. Among those on ART, 94.5% were virally suppressed in 2018.
Viral suppression improved significantly from 2013 to 2018, in all age and gender groups of PLHIV. However, almost half of HIV-positive young men remained unsuppressed, while the majority of virally unsuppressed PLHIV were women and older adults. To continue lowering HIV transmission, specific strategies are needed to increase viral suppression in those groups.
在艾滋病毒感染者（PLHIV）中广泛使用抗逆转录病毒疗法（ART）可提高人群中病毒抑制率，并可能降低发病率。无国界医生组织自 2011 年以来一直与南非卫生部合作，在埃绍韦/姆蓬戈兰韦（夸祖鲁-纳塔尔省）开展工作，以增加获得优质艾滋病毒服务的机会。在首次调查五年后，我们进行了第二次调查，以衡量艾滋病毒诊断和病毒抑制方面的进展，并确定仍然存在的差距。
2018 年采用与 2013 年相同的设计，实施了一项基于人群的、分层两阶段的横断面聚类调查。同意参加的 15-59 岁的参与者在家中接受访谈和艾滋病毒检测。艾滋病毒阳性者接受艾滋病毒病毒载量检测（病毒抑制定义为<1000 拷贝/毫升）。
共有 3278 人入组。2018 年，艾滋病毒阳性参与者病毒抑制的比例为 83.8%，而 2013 年为 57.1%（p<0.001），所有亚组均有所增加。最大的差距仍然存在于 15-29 岁的男性中，其中病毒抑制率为 51.5%。然而，在所有未被抑制的参与者中，60.3%为女性，57.4%为 30-59 岁的个体。2013 年至 2018 年间，艾滋病毒阳性意识从 75.2%提高到 89.9%，知情者中的抗逆转录病毒治疗覆盖率从 70.4%提高到 93.8%。2018 年，接受抗逆转录病毒治疗的人中，94.5%的人病毒得到了抑制。
从 2013 年到 2018 年，PLHIV 的所有年龄和性别组的病毒抑制率都显著提高。然而，几乎一半的艾滋病毒阳性年轻男性仍然未得到抑制，而大多数未被抑制的 PLHIV 为女性和老年成年人。为了继续降低艾滋病毒传播率，需要制定具体战略来提高这些人群的病毒抑制率。
