Center for Studies in Demography and Ecology, University of Washington, 206 Raitt Hall, UW, Box 353412, Seattle, WA, 98195-3412, USA.
Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
BMC Public Health. 2023 Apr 20;23(1):716. doi: 10.1186/s12889-023-15563-5.
INTRODUCTION: Antiretroviral medication coverage remains sub-optimal in much of the United States, particularly the Sothern region, and Non-Hispanic Black or African American persons (NHB) continue to be disproportionately impacted by the HIV epidemic. The "Ending the HIV Epidemic in the U.S." (EHE) initiative seeks to reduce HIV incidence nationally by focusing resources towards the most highly impacted localities and populations. This study evaluates the impact of hypothetical improvements in ART and PrEP coverage to estimate the levels of coverage needed to achieve EHE goals in the South. METHODS: We developed a stochastic, agent-based network model of 500,000 individuals to simulate the HIV epidemic and hypothetical improvements in ART and PrEP coverage. RESULTS: New infections declined by 78.6% at 90%/40% ART/PrEP and 94.3% at 100%/50% ART/PrEP. Declines in annual incidence rates surpassed 75% by 2025 with 90%/40% ART/PrEP and 90% by 2030 with 100%/50% ART/PrEP coverage. Increased ART coverage among NHB MSM was associated with a linear decline in incidence among all MSM. Declines in incidence among Hispanic/Latino and White/Other MSM were similar regardless of which MSM race group increased their ART coverage, while the benefit to NHB MSM was greatest when their own ART coverage increased. The incidence rate among NHB women declined by over a third when either NHB heterosexual men or NHB MSM increased their ART use respectively. Increased use of PrEP was associated with a decline in incidence for the groups using PrEP. MSM experienced the largest absolute declines in incidence with increasing PrEP coverage, followed by NHB women. CONCLUSIONS: Our analysis indicates that it is possible to reach EHE goals. The largest reductions in HIV incidence can be achieved by increasing ART coverage among MSM and all race groups benefit regardless of differences in ART initiation by race. Improving ART coverage to > 90% should be prioritized with a particular emphasis on reaching NHB MSM. Such a focus will reduce the largest number of incident cases, reduce racial HIV incidence disparities among both MSM and women, and reduce racial health disparities among persons with HIV. NHB women should also be prioritized for PrEP outreach.
引言：在美国的许多地方，包括南部地区，抗逆转录病毒药物的覆盖率仍然不理想，非西班牙裔黑人和非洲裔美国人（NHB）仍然受到艾滋病毒流行的不成比例的影响。“在美国终结艾滋病毒流行”（EHE）倡议旨在通过将资源集中在受影响最严重的地方和人群，来减少全国的艾滋病毒发病率。本研究评估了假设的抗逆转录病毒治疗和暴露前预防（PrEP）覆盖率提高的影响，以估计在南部实现 EHE 目标所需的覆盖水平。
方法：我们开发了一个包含 50 万名个体的随机、基于代理的网络模型，以模拟艾滋病毒流行和假设的抗逆转录病毒治疗和 PrEP 覆盖率提高。
结果：在 90%/40%的抗逆转录病毒治疗和 PrEP 覆盖率和 100%/50%的抗逆转录病毒治疗和 PrEP 覆盖率下，新感染减少了 78.6%和 94.3%。到 2025 年，每年的发病率下降超过 75%，到 2030 年，每年的发病率下降 90%/40%和 90%，采用 100%/50%的抗逆转录病毒治疗和 PrEP 覆盖率。NHB 男男性行为者（MSM）中抗逆转录病毒治疗覆盖率的增加与所有 MSM 的发病率线性下降有关。西班牙裔/拉丁裔和白种人/其他 MSM 的发病率下降相似，无论哪个 MSM 种族群体增加了他们的抗逆转录病毒治疗覆盖率，而 NHB MSM 自己的抗逆转录病毒治疗覆盖率增加时，受益最大。当 NHB 异性恋男性或 NHB MSM 分别增加他们的抗逆转录病毒治疗使用率时，NHB 女性的发病率下降了三分之一以上。
结论：我们的分析表明，达到 EHE 目标是有可能的。通过增加 MSM 和所有种族群体的抗逆转录病毒治疗覆盖率，可以最大程度地减少艾滋病毒发病率。无论种族群体抗逆转录病毒治疗的起始率有何差异，所有种族群体都能从中受益。提高抗逆转录病毒治疗覆盖率至>90%应是优先事项，特别是要特别关注 NHB MSM。这样的重点将减少最大数量的新发病例，减少 MSM 和女性之间的种族艾滋病毒发病率差距，并减少艾滋病毒感染者之间的种族健康差距。NHB 女性也应优先考虑接受 PrEP 宣传。
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