US Centers for Disease Control and Prevention, Lilongwe, Malawi.
US Centers for Disease Control and Prevention, Lilongwe, Malawi.
Lancet HIV. 2023 Sep;10(9):e597-e605. doi: 10.1016/S2352-3018(23)00144-3. Epub 2023 Aug 13.
In 2014, UNAIDS set the goal of ending the AIDS epidemic by 2030 through the achievement of testing and treatment cascade targets. To evaluate progress achieved and highlight persisting gaps in HIV epidemic control in Malawi, we aimed to compare key indicators (prevalence, incidence, viral load suppression, and UNAIDS 95-95-95 targets) from the 2015-16 and 2020-21 Malawi Population-based HIV Impact Assessment (PHIA) survey results.
The Malawi PHIAs were nationally representative, cross-sectional surveys with a two-stage cluster sampling design. The first survey was conducted between Nov 27, 2015, and Aug 26, 2016; the second survey was conducted between Jan 15, 2020, and April 26, 2021. Our analysis included survey participants aged 15-64 years. Participants were interviewed and a 14 mL blood sample was collected and tested for HIV infection using the national rapid testing algorithm. For each survey, we estimated key HIV epidemic indicators and achievement of 95-95-95 targets. The risk ratio (RR) of the indicators between surveys were computed and considered significant at a confidence level of 0·05. All results were weighted, and self-reported awareness and treatment status were adjusted to account for detection of antiretrovirals.
Our analysis included 17 187 participants aged 15-64 years in 2015-16 and 21 208 in 2020-21 who participated in the surveys and blood draw. In the 2020-21 survey, 88·4% (95% CI 86·7-90·0) of people living with HIV were aware of their HIV-positive status; of those aware, 97·8% (97·1-98·5) were on antiretroviral therapy; and of those on treatment, 96·9% (95·9-97·7) were virally suppressed. Between surveys, the national HIV prevalence decreased significantly from 10·6% (10·0-11·2) to 8·9% (8·4-9·5) with RR 0·85 (95% CI 0·78-0·92; p<0·0001). The annual HIV incidence decreased from 0·37% (0·20-0·53) to 0·22% (0·11-0·34) with RR 0·61 (95% CI 0·31-1·20; p=0·15). The population viral load suppression increased from 68·3% (66·0-70·7) in 2015-16 to 87·0% (85·3-88·5) in 2020-21 (RR 1·27 [95% CI 1·22-1·32]; p<0·0001).
These results suggest that Malawi had already surpassed the UNAIDS viral load suppression target for 2030 (85·7%) by 2020-21. Through strategies and evidence-informed interventions implemented in the last half decade, especially scale-up of effective HIV treatment, Malawi has made tremendous progress, including decreasing HIV prevalence and incidence and achieving both the second and third 95 targets ahead of 2030. To address the first 95, efforts in HIV diagnosis should focus on males and younger age groups. There is a continued need for effective linkage to care, retention on antiretroviral therapy, and adherence support to maintain and build on progress.
US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
2014 年，联合国艾滋病规划署（UNAIDS）设定了到 2030 年通过实现检测和治疗连续体目标终结艾滋病流行的目标。为了评估在马拉维艾滋病毒流行控制方面取得的进展，并突出仍然存在的差距，我们旨在比较 2015-16 年和 2020-21 年马拉维基于人口的艾滋病毒影响评估（PHIA）调查结果中的关键指标（流行率、发病率、病毒载量抑制率以及 UNAIDS 95-95-95 目标）。
马拉维 PHIAs 是具有两阶段聚类抽样设计的全国代表性横断面调查。第一次调查于 2015 年 11 月 27 日至 2016 年 8 月 26 日进行；第二次调查于 2020 年 1 月 15 日至 2021 年 4 月 26 日进行。我们的分析包括年龄在 15-64 岁的调查参与者。参与者接受了访谈，并采集了 14 毫升血液样本，使用国家快速检测算法检测艾滋病毒感染情况。对于每一次调查，我们都估算了关键的艾滋病毒流行指标和 95-95-95 目标的实现情况。计算了两次调查中指标的风险比（RR），置信水平为 0.05 时认为差异具有统计学意义。所有结果均进行了加权处理，并对自我报告的知晓率和治疗状况进行了调整，以考虑到抗逆转录病毒药物的检测情况。
我们的分析包括 2015-16 年调查中年龄在 15-64 岁的 17187 名参与者和 2020-21 年调查中年龄在 15-64 岁的 21208 名参与者，他们都参加了调查和采血。在 2020-21 年的调查中，88.4%（95%CI 86.7-90.0）的艾滋病毒感染者知晓自己的艾滋病毒阳性状况；在知晓状况的人群中，97.8%（97.1-98.5）正在接受抗逆转录病毒治疗；在接受治疗的人群中，96.9%（95.9-97.7）的病毒载量得到抑制。与调查相比，全国艾滋病毒流行率从 10.6%（10.0-11.2）显著下降到 8.9%（8.4-9.5），RR 为 0.85（95%CI 0.78-0.92；p<0.0001）。年艾滋病毒发病率从 0.37%（0.20-0.53）下降到 0.22%（0.11-0.34），RR 为 0.61（95%CI 0.31-1.20；p=0.15）。人群病毒载量抑制率从 2015-16 年的 68.3%（66.0-70.7）增加到 2020-21 年的 87.0%（85.3-88.5）（RR 1.27 [95%CI 1.22-1.32]；p<0.0001）。
这些结果表明，马拉维到 2020-21 年已经提前实现了到 2030 年达到 UNAIDS 病毒载量抑制率 85.7%的目标。在过去五年中，通过实施战略和基于证据的干预措施，特别是有效艾滋病毒治疗的扩大，马拉维取得了巨大进展，包括降低艾滋病毒流行率和发病率，并提前到 2030 年实现了第二和第三个 95 目标。为了解决第一个 95 目标，艾滋病毒诊断方面的工作应重点关注男性和年轻群体。仍然需要有效的衔接护理、保持抗逆转录病毒治疗和坚持药物治疗以维持和巩固进展。
美国疾病控制与预防中心通过美国总统艾滋病紧急救援计划提供资金。
