British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
BMC Public Health. 2022 May 21;22(1):1022. doi: 10.1186/s12889-022-13415-2.
In 2010, the Canadian province of British Columbia (BC) initiated the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) program to improve HIV testing, linkage to care, and treatment uptake, thereby operationalizing the HIV Treatment as Prevention (TasP) framework at the population-level. In this analysis, we evaluated self-reported HIV care experiences and therapeutic outcomes among people diagnosed with HIV prior to and after implementation of this provincial program.
A cross-sectional analysis was performed on the baseline data of a cohort of people living with HIV (PLWH) (19 years and older) in the province of BC sampled from July 2016 to September 2018. All participants consented to linking their survey data to the provincial HIV treatment registry. Individuals diagnosed with HIV from January 1 2000-December 31 2009 were classified as pre-intervention and those diagnosed January 1 2010-December 31 2018 as post-intervention cohorts. Bivariate analyses were run using Chi-square and Wilcoxon Rank Sum tests. Cox proportional hazards regression model demonstrates time to antiretroviral therapy (ART) initiation (from HIV baseline) and virological suppression (2 consecutive plasma viral load measurements < 200 copies/ml).
Of the 325 participants included in this analysis, 198 (61%) were diagnosed with HIV in the pre-intervention era and 127 (39%) in the post-intervention era. A higher proportion of participants in post-intervention era were diagnosed at walk-in clinics (45% vs. 39%) and hospitals (21% vs. 11%) (vs pre-intervention) (p = 0.042). Post-intervention participants had initiated ART with less advanced HIV disease (CD4 count 410 vs. 270 cells/ul; p = 0.001) and were less likely to experience treatment interruptions at any point in the 5 years after HIV diagnosis (17% vs. 48%; p < 0.001). The post-intervention cohort had significantly more timely ART initiation (aHR: 5.97, 95%CI 4.47, 7.97) and virologic suppression (aHR: 2.03, 95%CI 1.58, 2.60) following diagnosis, after controlling for confounders.
We found favourable treatment experiences and more timely ART initiation and virologic suppression after a targeted TasP provincial program. Our results illustrate the importance of accessible low-barrier HIV testing and treatment in tackling the HIV epidemic.
2010 年，加拿大不列颠哥伦比亚省（BC 省）启动了“寻找和治疗以优化预防艾滋病毒/艾滋病（STOP HIV/AIDS）”计划，以改善艾滋病毒检测、与护理的衔接和治疗的接受度，从而在人群层面实施艾滋病毒治疗即预防（TasP）框架。在这项分析中，我们评估了在该省级项目实施之前和之后诊断出艾滋病毒的人群中自我报告的艾滋病毒护理经验和治疗结果。
对 2016 年 7 月至 2018 年 9 月从 BC 省抽样的艾滋病毒感染者（PLWH）（19 岁及以上）队列的基线数据进行了横断面分析。所有参与者都同意将他们的调查数据与省级艾滋病毒治疗登记处相链接。2000 年 1 月 1 日至 2009 年 12 月 31 日诊断出的艾滋病毒感染者被归类为干预前队列，2010 年 1 月 1 日至 2018 年 12 月 31 日诊断出的艾滋病毒感染者被归类为干预后队列。使用卡方检验和 Wilcoxon 秩和检验进行了双变量分析。Cox 比例风险回归模型展示了从艾滋病毒基线开始的抗逆转录病毒治疗（ART）开始时间（和病毒学抑制（两次连续的血浆病毒载量测量 < 200 拷贝/ml）。
在这项分析中，纳入了 325 名参与者，其中 198 名（61%）在干预前时期被诊断出患有艾滋病毒，127 名（39%）在干预后时期被诊断出患有艾滋病毒。干预后时期参与者中有更高比例的人在门诊诊所（45% vs. 39%）和医院（21% vs. 11%）（vs 干预前）（p = 0.042）被诊断出来。干预后时期的参与者在开始接受 ART 时 HIV 疾病的进展程度较轻（CD4 计数 410 与 270 个细胞/μl；p = 0.001），并且在艾滋病毒诊断后的 5 年内更不可能经历任何治疗中断（17% vs. 48%；p < 0.001）。在控制了混杂因素后，干预后队列在诊断后具有明显更及时的 ART 启动（aHR：5.97，95%CI 4.47，7.97）和病毒学抑制（aHR：2.03，95%CI 1.58，2.60）。
我们发现，在实施了有针对性的 TasP 省级项目后，治疗效果良好，ART 启动和病毒学抑制更加及时。我们的研究结果说明了提供无障碍、低门槛的艾滋病毒检测和治疗对于应对艾滋病毒流行的重要性。
