Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Zambart, Lusaka, Zambia.
J Int AIDS Soc. 2023 Aug;26(8):e26155. doi: 10.1002/jia2.26155.
Universal HIV testing and treatment aims to identify all people living with HIV and offer them treatment, decreasing the number of individuals with unsuppressed HIV and thus reducing HIV transmission. Longitudinal follow-up of individuals with and without HIV in a cluster-randomized trial of communities allowed for the examination of community- and individual-level measures of HIV risk and HIV incidence.
HPTN 071 (PopART) was a three-arm cluster-randomized trial conducted between 2013 and 2018 that evaluated the use of two combination HIV prevention strategies implemented at the community level to reduce HIV incidence compared to the standard of care. The trial, conducted in 21 communities in Zambia and South Africa, measured HIV incidence over 36 months in a population cohort of ∼2000 randomly selected adults per community aged 18-44. Multilevel models were used to assess the association between HIV incidence and community- and individual-level socio-demographic and behavioural risk factors, as well as prevalence of detectable virus (PDV) defined as the estimated proportion of the community with unsuppressed viral load.
Overall HIV incidence was 1.49/100 person-years. Communities with less financial wealth and communities with more individuals reporting having sex partners outside of the community or two or more sexual partners had higher HIV incidence. PDV at 2 years of study was 6.8% and was strongly associated with HIV incidence: for every 50% relative reduction in community PDV, there was a 49% (95% confidence interval [CI]: 37%-58%, p < 0.001) relative decrease in HIV incidence. At the individual level; socio-economic status, AUDIT score, medical male circumcision and certain sexual behaviours were associated with HIV risk.
Using data from the PopART randomized trial, we found several associations of HIV incidence with community-level measures reflecting the sexual behaviour and socio-economic make-up of each community. We also found a strong association between community PDV and HIV incidence supporting the use of PDV as a tool for monitoring progress in controlling the epidemic. Lastly, we found significant individual-level factors of HIV risk that are generally consistent with previous HIV epidemiological research. These results have the potential to identify high high-incidence communities, inform structural-level interventions, and optimize individual-level interventions for HIV prevention.
ClinicalTrials.gov number, NCT01900977, HPTN 071 [PopArt].
普遍艾滋病毒检测和治疗旨在发现所有艾滋病毒感染者，并为他们提供治疗，从而减少未抑制艾滋病毒人数，进而减少艾滋病毒传播。在社区层面进行的一项以群组为基础的、针对艾滋病毒的随机对照试验中，对群组内和群组间的艾滋病毒风险和艾滋病毒发病率进行了纵向随访，从而能够检查艾滋病毒风险和艾滋病毒发病率的社区和个体层面的措施。
HPTN 071（PopART）是一项在 2013 年至 2018 年期间进行的三臂群组随机对照试验，评估了在社区层面实施的两种艾滋病毒综合预防策略的使用情况，以降低艾滋病毒发病率，与标准护理进行比较。该试验在赞比亚和南非的 21 个社区进行，在每个社区约 2000 名随机选择的 18-44 岁成年人中，在 36 个月的人群队列中测量艾滋病毒发病率。使用多水平模型评估艾滋病毒发病率与社区和个体层面社会人口和行为风险因素之间的关联，以及可检测病毒（PDV）的流行率（定义为社区中未抑制病毒载量的估计比例）。
总体艾滋病毒发病率为 1.49/100 人年。金融财富较少的社区和报告有社区外性伴侣或两个以上性伴侣的社区的艾滋病毒发病率较高。研究 2 年时的 PDV 为 6.8%，与艾滋病毒发病率密切相关：社区 PDV 相对减少 50%，艾滋病毒发病率相对降低 49%（95%置信区间[CI]：37%-58%，p<0.001）。在个体层面，社会经济地位、AUDIT 评分、男性医疗性环切术和某些性行为与艾滋病毒风险相关。
利用 PopART 随机试验的数据，我们发现艾滋病毒发病率与反映每个社区性行为和社会经济构成的社区层面措施之间存在多种关联。我们还发现社区 PDV 与艾滋病毒发病率之间存在很强的关联，支持将 PDV 用作监测控制疫情进展的工具。最后，我们发现艾滋病毒风险的个体层面因素具有重要意义，这些因素通常与之前的艾滋病毒流行病学研究一致。这些结果有可能确定高发病率社区，为结构层面的干预措施提供信息，并优化艾滋病毒预防的个体层面干预措施。
临床试验.gov 编号，NCT01900977，HPTN 071[PopArt]。
